“Is it a Boy or a Girl?”: Birth and Gender in Twenty-First Century America and Beyond

It is the third word said about each of us and the answer to the first question ever asked about all of us: boy or girl. When a baby is born a doctor looks at their genitals. If the doctor sees a penis they declare, “Its a boy!” If the doctor does not see a penis they declare, “Its a girl!” Then a permanent “M” or “F” is inscribed on the infant’s birth certificate that will follow them for the rest of their life. The new arrival’s gender becomes government record before the child even knows what gender is let alone their place in it.

When new parents announce a birth the first question on everyone’s mind is, “Is it a boy or a girl?” Then the parents dress the newborn in either pink or blue to make sure there is no confusion over the appearance of the child’s genitals and, by extension, which gender within the binary they are raising the child to be for the rest of their life. If the parents inquired what their expected child’s reproductive anatomy looked like on a prenatal ultrasound they begin to gender the coming baby before the child even comes out of the womb. This early gendering sets into a motion an array of behaviors from buying certain toys, clothes, and decorations to choosing from only certain names, throwing “gender reveal” parties, and forming strong expectations regarding the infant’s future. These expectations are oftentimes so strong any break with them is met with pain, grief, distress, fear, anger, and violence.

For those of us who are intersex, being assigned a gender can be a source of great pain. When doctors cannot determine a baby’s sex immediately a medical emergency is set in motion. Surgeons are called in, endocrinologists are consulted, whole medical teams are formed, tests are administered, and the offending ambiguous body parts are surgically modified to fit into what the wider society has deemed to be standard for male or female. In most cases parents are not even consulted on these decisions and if they are consulted they are usually pressured into going along with normalizing procedures regardless of medical necessity or the serious life long consequences for the child, which often include sterility and lose of genital feeling. Not to mention all of the ethical issues surrounding the hormonal treatments many intersex people go through in adolescence in an effort to keep shoe horning them into the side of the gender binary to which they were assigned regardless of their actual sense of self.

Then there are those of us who are trans and do not identify with the gender we were assigned at birth. Such an early misidentification often leads to a great deal of distress and struggle in a society built on a strict binary. Trans people are more likely to attempt suicide, face violence, be denied health care, and experience poverty as a result of institutionalized cissexism and transphobia with trans women of color being particularly vulnerable. For many of us in the trans community our birth assigned genders are horrible mistakes we spend a lifetime correcting at great personal risk.

In many ways the different experiences of interphobia and transphobia intersect in how the medical gaze aggressively genders bodies from birth to death with no room for variation even in newborns. The surgeries many trans people elect to undergo in the process of affirming their gender identities had their start being performed on intersex infants and children who could not consent to such procedures. The same hormonal treatments trans people have to go through all kinds of hoops to gain access to are given without any question to intersex children. Both intersex and trans people find themselves having to educate medical professionals about their bodies in ways their non-intersex and cisgender counterparts never do. Those of us who live at the intersections of intersexuality and transness find our experiences are incoherent even within trans and intersex communities. All of this has at least some roots in deeply entrenched cultural beliefs that gender is easily recognizable at birth, binary, natural, biologically determined, and fixed. These are the cultural beliefs that make grown people think they know who a child is based on their genitalia and lead them to be fearful whenever faced with any challenge to those beliefs, even when said challenge comes in the form of a helpless baby.

This is the reality of birth and gender in twenty-first century America, where a simple “M” or “F” plays a role in determining the civil rights and privileges a person is afforded in important areas of life and being intersex or trans is met with oppression. Fortunately there are signs these practices are changing for the better. Transgender adults and children, in particular, are gaining visibility. Nonbinary identities are becoming better known to the general public. Intersex activists have made strides in raising awareness and working toward changing intersex health care. More parents are questioning and even out right resisting societal pressures to impose a particular gender on their children based solely on genitalia, especially when they are only infants.

I dream of a day when we put our babies in rainbow hats and are not so quick to assign gender to infants, or at least learn to take such assignments with a grain of salt. Besides a gender assignment at birth doesn’t yield all the information we are told it does even when it comes to biology. No one is testing the karyotypes of babies or conducting ultrasounds of their internal reproductive systems let alone thinking of the possibility the child may be trans. For all anyone knows in those first moments of life the healthy newborn everyone assumes has ovaries, a uterus, and XX chromosomes because the doctor said its a girl actually has internal testes and  XY chromosomes or the baby the doctor so confidently declared to be a boy due to the presence of a penis may one day disagree with that doctor’s assessment and grow up to be a woman.

So the next time someone you know has a baby maybe just ask if the baby is healthy rather than the classic, “Is it a boy or a girl?” Afterall you’re asking about a baby. No one knows who they are yet.

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Introductions to Intersex Traits: What is Klinefelter Syndrome?

This is the third in a series of posts in which I cover the basics of a particular intersex trait. For the purposes of this blog an intersex trait is defined as a bodily characteristic or set of bodily characteristics that have been determined to not be standard for male or female. This determination can be primarily chromosomal, hormonal, gonadal, and/or genital. Some examples include Androgen Insensitivity Syndrome, Congenital Androgen Hyperplasia, and cliormegaly. Here the focus will be on Klinefelter syndrome.

Klinefelter syndrome is a genetic condition in which a person is born with a 47XXY karyotype or a 47XXY/46XY karyotype instead of a typical 46XX karyotype or 46XY karyotype. This particular syndrome occurs in 1 out of 500 to 1 in 1,000 live male assigned births and manifests in a variety of ways that range from the mild to the severe. No two cases are the same and it is likely any one individual will only experience a hand full of symptoms in their lifetime.

At birth Klinefelter syndrome commonly results in genitals that are considered typical for males and most are not diagnosed until later. A diagnosis is usually made when puberty is not be progressing as expected during adolescence or issues of infertility arise in adulthood, although some are diagnosed before birth through prenatal genetic testing. Common physical signs of Klinefelter syndrome include tall stature, long legs, small, firm testes, small penis, enlarged breasts, and little to no body and facial growth.

Beyond the aforementioned physical signs, Klinefelter syndrome is also associated with various learning difficulties including difficulties with memory, attention, verbal communication, and social skills. When present, these difficulties can be overcome with appropriate accommodations in school and support from family and friends as well as others in Klinefelter community.

In adulthood the most common issue associated with Klinefelter syndrome is infertility due to a lack of testiculuar development. In short, the testes do not produce sperm and even in cases when sperm is produce they often die off. Today there are options for those who do wish to have children including adoption and, in some cases, sperm extraction, freezing, and In Vitro Fertilization (IVF) with Intra-clytoplasmic sperm injection (ICSI).

Along with infertility, adults with Klinefelter syndrome also have an increased risk for osteoporosis, breast cancer, varicose veins, and autoimmune disorders than their XY counterparts. These increased risks is often attributed to low testosterone levels or the presence of the second chromosome. There is also an increased risk for diabetes, lung disease, taurodontism, sleep apnoea, essential tremor and unbalanced gait than the general population. While this list of possible health issues may look intimidating, it is important Klinefelter syndrome presents in a wide range of ways and it is highly unlikely any one individual will have experience all of these health issues over their lifetime. Although it is important all of these health risks be taken into account when receiving health care.

Beyond monitoring for potential health and fertility issues associated with Klinefelter syndrome, other conventional medical interventions to a diagnosis of Klinefelter syndrome in adolescence and beyond often include testosterone replacement therapy and surgical removal of breast tissue in the interest of promoting a more conventional adult male appearance. While it is true the majority do grow up to live comfortably as men and benefit from such treatment plans, this is not the case for everyone. It is important to recognize people with Klinfelter syndrome come in all genders, gender expressions, and sexualities and with diversity of identities comes diversity in medical and psychological needs.

In the end informed consent in intersex health care is paramount and everyone has the right to bodily integrity. For more information on Klinfelter syndrome, informed consent, bodily integrity and personal narratives from within the Klinfelter community please visit the resources below.

Sources and Further Reading

  1. http://www.isna.org/faq/conditions/klinefelter
  2. https://www.genome.gov/19519068/
  3. http://www.ksa-uk.net/
  4. http://www.aaksis.org/
  5. http://klinefeltersyndrome.org/Stefan.htm

Book Review–Standing Tall with Turner Syndrome edited by Claudette Aharon

In a highly medicalized world it is important for those of us who are intersex to exchange in personal narratives centered on our experiences living in our particular bodies beyond clinics, charts, test results, treatment plans, procedures, lists of symptoms, diagnostic nomenclature, and normalization. When we share stories and information with one another we can empower each other. Just the act of sharing stories in community allows us to learn from one another away from the constraints of doctors’ offices. It makes us feel less alone and deepens our sense of community. When medical professionals hear our stories it gives them a chance to improve the care they provide and see us more as human beings and not just patients or issues to be managed or fixed. That is why the autobiographical essays like the ones collected in Standing Tall with Turner Syndrome are so important for the Turners community.

The essays cover a wide range topics including sexuality, hormone replacement therapy, interactions with medical professionals, gender expression, relationships, family life, and more. Turners women and girls in particular are given opportunities to see themselves accurately portrayed in the stories the contributors share. The essayists themselves are of ages from older women to young adults and a few are even people of color. This helps to expand representation for the Turners community beyond the usual focus on white girls and hormonal treatments. However diverse representation in terms of gender identity and sexual orientation is limited with only a brief acknowledgement lesbian with Turner syndrome exist. Otherwise the assumption everyone with Turner syndrome is a feminine, heterosexual, female, and cisgender are left unchallenged. Unfortunately such a lack of LGBTQ+ is unfortunately quite common within the wider Turners community. Hopefully this will change as visibility increases for LGBTQ+ and Turners communities including those of us who live at the intersection of these experiences.

Readers who do not have Turner syndrome are given a window into what it is like to live with the condition and what it means on a personal as well as a medical level. The sections on the biology of Turner syndrome are straight forward, easy to understand, and effective for teaching the basics of the condition. It avoids the common pit falls sources on Turner syndrome fall into like just giving a long of symptoms or using confusing medical jargon. All of this makes it an excellent educational resource.

In the end I would recommend this book to anyone who wants to learn more about Turner syndrome, especially to those who are newly diagnosed and their families and friends. It is the kind of book I wish was in existence when I was diagnosed and I think it  also would have been really helpful to my family during that difficult time.

From a Drag Queen Sea Witch to a Misunderstood Ice Queen: The Evolution of Queerness, Femininity, and Villainy in Disney Movies

If you live in the United States odds are you have been exposed to Disney at some point in your life. As for me, my very first memory is watching The Lion King when I was a little over one year old. As a toddler I was obsessed with Mary Poppins and watched it on repeat. Like any true ’90s kid I was raised on Disney animated movies like The Little Mermaid, Aladdin, and Mulan. Even as I grew older I continued to see the latest Disney animated movies in theaters and enjoyed family vacations to Disney World and Disney Land. Now as a young adult I still watch Disney movies and I have just returned from my thirteenth Disney theme parks vacation. Over time the way I consume Disney theme parks and movies has evolved as I begin to notice details I had missed when I was a child. Among these details is the surprising amount of queerness for a film company built on a reputation for being good, wholesome, (straight) family fun.

It can take a few viewings to pick up on the subtle undertones of queerness in the flavor of various Disney animated films, but once noticed it cannot be ignored regardless if the filmmakers intended to code these characters as queer or not. An excellent example of this can be found in Ursula from The Little Mermaid. The powerful sea witch is based on the drag queen Divine (a fact that will come as no surprise to anyone familiar with drag queen performances). Many fans view The Lion King‘s fratricidal villain, Scar, as gay. Some have asserted Aladdin’s Jafar is arguably more interested in Aladdin than he is with Jasmine. Lyricist Howard Ashman saw himself as a gay man with AIDS in the beast. He publicly interpreted the curse in Beauty and the Beast as a metaphor for what its like to live with the AIDs. More recently many in gay and lesbian communities in particular have cited Elsa’s ice powers as a metaphor for queerness and think of the ice queen’s show stopping number “Let It Go” as a coming out anthem. So the next time you hear someone complain about the new Beauty and the Beast‘s “exclusively gay moment” just remind them Disney has been having queer “moments” for quite some time.

Now it must be acknowledged the majority of the characters mentioned are villains and femme or effeminate. In many ways these characters fit into a long tradition of vilifying queerness and femininity that is far larger and older than Disney. For this reason these films must be consumed with caution and a healthy amount of suspicion lest they contribute to the internalization of the idea queerness and femininity are evil. Yet in a world where queer representations are few and far between some queer viewers find mirrors in the drag-esque stylings of Ursula and the flamboyance of Scar and Jafar. Oftentimes the villains are more compelling than the oftentimes bland hero and heroines that populate Disney films. They drive the major external conflicts their respective hero(ines) must face and in doing so give the stories they inhabit life. After all, what would Ariel, Aladdin, and Simba have to do without Ursula, Jafar, and Scar plotting and scheming in their way? However, as fun as these characters may be, a list filled with villains who are not even explicitly queer and play into a long tradition of heterosexism and misogyny isn’t very satisfying media representation.

Fortunately, over the past few decades queer representations in Disney movies have evolved from the subtly coded queerness of the villainous sea witch Ursula. Now queer viewers can find a mirror for themselves in Elsa the misunderstood ice queen who lets her freak flag fly and whose primary relationship in life is with another woman, albeit her sister. Many fans are hoping for more explicit and intentional queer representation in Frozen 2 with Elsa at the heart of a lesbian love story.

Only time will tell if same gender love stories from Disney will ever brace the world’s multitude of screens. In the meantime we can be mindful of what we consume, take whatever pleasure we can in the media representation available, and encourage better representations with our views and our wallets.

Sources and Further Reading 

  1. https://mic.com/articles/170056/the-original-beauty-and-the-beast-cartoon-was-a-metaphor-for-aids#.fXEYfa0qO
  2. https://tjwest3.com/2013/11/13/the-queer-pleasures-of-disney-villains/