1. INTERSEX LIVES
Presented By
Veronica Drantz, PhD
Prepared for
H.E.R. Day
at the
Center on Halsted
March 10, 2012

2. What’s the “I” in LGBTI?
 I = Intersex
– I for Invisible
– I for Isolation
 LGBTI
– Much in common
– All are victims of the “gender binary“
Elizabeth Reis. Bodies in Doubt: An American History of Intersex. The Johns Hopkins University
Press. (2009)

3. The Myth: “The Gender Binary”
 Gametes are binary (eggs or sperm)
 Organisms that make the gametes are not binary!

4. Intersex People
Curtis Hinkle - Founder
Organization Intersex International

5. Some 4% Of People Are Not
Clearly Male Or Female
 Frequency depends on how you define
intersex and what conditions are included
under this umbrella term
 Most intersex conditions are not life-
threatening and do not require treatment
 Some people are not aware that they are
intersex
 Many are never diagnosed
 There are many different kinds of intersex
people

6. Intersex People Are Not
Standard Males Or Females
 Intersex people
– Differ physically from the “standard” male or
female
– Difference is congenital, due to atypical sexual
development
 These differences involve
– Genes/chromosomes
– Gonads
– Hormones
– Genitals
 May have features of both male and
female at once or may have no clearly
defined sexual features at all

7. Intersex People - Natural Variants
 Everyone, including intersex persons,
are natural variations on the human
theme
 All of us are unusual in some way; we
all carry unusual genes
 Diversity in a population is an biological
asset, not a liability

8. Sexual Development –
What Do We Know?
 Sex has many levels in people
– Genetic Sex – Chromosomes (X & Y in mammals only)
– Gonadal Sex – Ovaries/Testis (primary sex characteristic)
– Hormonal Sex –Testosterone/Estrogen
– Somatic Sex – Body anatomy/physiology
– Psychological Sex - Sexual identity
– Sexual Attraction – Sexual orientation

9. “Organization – Activation” Mechanism
of Sexual Development
 Organization - before birth
– Two kinds of sexual programming of body
 Genetic: 46 XX vs. 46 XY
 Hormonal: androgen or its absence
 Activation – at puberty
– By steroid hormones from gonads
Milton Diamond. Clinical implications of the organizational and activational effects of hormones. HORMONES AND BEHAVIOR
55:621–632 (2009)

10. Sexual Programming
by Sex Chromosomes
 Genes on sex chromosomes are
expressed in brain of embryo
(before gonads develop so hormone influence is not a factor)
Laura L. Carruth, Ingrid Reisert & Arthur P. Arnold. Sex chromosome genes directly affect brain sexual differentiation NATURE NEUROSCIENCE 5,
933 - 934 (2002)
Phoebe Dewing, Tao Shi, Steve Horvath, Eric Vilain Sexually dimorphic gene expression in mouse brain precedes gonadal Differentiation
MOLECULAR BRAIN RESEARCH 118 (2003) http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/4_vilain_et_al.pdf
• Multiple genes
determine gonad
differentiation
http://quizlet.com/3597081/x-and-y-chromosomes-flash-cards

11. Sexual Programming
by Androgen
 Female body plan is “default” in mammals
– No significant hormone secretion by ovaries in
developing female
 Androgen (testosterone) acts during
“critical periods” of development
– Testosterone is secreted by testes of typical
developing male
 Epigenetic effects of testosterone or its
absence during these critical periods are
lifelong and widespread in body

12. Sexual
Differentiation
of
Internal
Genitalia
Figure 25-4 Embryonic
differentiation of male and
female internal genitalia
(genital ducts) from
wolffian (male) and
müllerian (female)
primordia.

13. Sexual
Differentiation of
External Genitalia
Figure 25-5 Differentiation of male
and female external genitalia from
indifferent primordial structures in the
embryo.

14. Male Is Altered Female !!!
 Mammalian body plan is inherently female
 Every individual’s body plan is a variation on
the female theme
– Default (female)
– Fully altered (male)
– Partly altered (intersex)
 Everyone falls on some point of the
continuum from female (gynemorphic) to
male (andromorphic)

15. Prader Scale:
Five Degrees of Virilization –
Urogenital Sinus and External Genitalia
Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And
Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81
(2004)

16. 4 Sexes!
 Four
“transcriptional
sexes” in PBMC
– XX/no T
– XY/T
– XX/T
– XY/no T
*PBMC = peripheral blood mononuclear cells
Holterhus P-M, Bebermeier J-H, Werner R, Demeter J,
Richter-Unruh A, Cario G, Appari M, Siebert R, Riepe
F, Brooks JD, Hiort O. Disorders of sex development
expose transcriptional autonomy of genetic sex and
androgen-programmed hormonal sex in human blood
leukocytes BMC GENOMICS 10:292 (2009)

17. 4 Sexes!
 157 genes
expressed
differently in
males vs. females
– Sex chromosome
programming of
11 genes
– Androgen-
dependent
programming of
146 genes (not
affected by
circulating
hormones)
Holterhus P-M, Bebermeier J-H, Werner R, Demeter J, Richter-Unruh A, Cario G,
Appari M, Siebert R, Riepe F, Brooks JD, Hiort O. Disorders of sex
development expose transcriptional autonomy of genetic sex and
androgen-programmed hormonal sex in human blood leukocytes BMC
GENOMICS 10:292 (2009)

18. Sexual Identity & Orientation –
Nature or Nurture?
 The genitalia are obviously organized before birth,
and we obviously do not learn or choose our genetic
sex, gonadal sex, hormonal sex, or somatic sex
 But what about sexual behavior? Sexual identity?
Sexual orientation? Innate or learned/chosen?
 Is the brain, like the body, organized sexually before
birth?
 Evidence for Organization-Activation Mechanism
– David Reimer story
– Intersex people (AIS, CAH, cloacal exstrophy)
– Brain work (nonhuman mammals, humans)

19. John Money
"Neutrality-at-Birth“
Theory
 “Sexual behavior and orientation as Psychologist
male or female does not have an
innate, instinctive basis”
Money, J. Hermaphroditism, gender and precocity in hyperadrenocorticism: Psychologic findings. BULLETIN OF THE JOHNS HOPKINS HOSPITAL
96:253-264 (1955)
– Postulate 1: Individuals are psychosexually neutral
at birth
– Postulate 2: Healthy psychosexual development is
intimately related to the appearance of the genitals
 No evidence to support this theory (serious
flaws in Money’s statistical and research methods)
*Cappon D, Ezrin C, Lynes P. Psychosexual identification (psychogender) in the intersexed THE CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL 4:90-106 (1959)

20. Milton Diamond
“Sexuality-at-Birth"
Theory
 Prenatal genetic and hormonal Biologist
influences predispose at birth to a male or
female sexual identity
 Inherent sexuality provides built-in "bias“ with
which the individual interacts with environment;
sexual behavior and thus gender role, are not
neutral and without initial direction at birth
 Organization – Activation Mechanism
 Evolutionary view

21. 1959 – Breakthrough at
University of Kansas
 Phoenix CH, Goy RW, Gerall AA, Young WC.
Organizing action of prenatally administered
testosterone propionate on the tissues
mediating mating behavior in the female guinea
pig. ENDOCRINOLOGY 65:369-382 (1959)
 Milton Diamond
– Felt that fellow scientists were too cautious failing to
link their animal findings to human situation
– Decided to write essay challenging psychosexual
neutrality theory

22. Diamond Versus Money
• Diamond challenges Money - 1965
• Diamond, Milton. A critical evaluation of the ontogeny
of human sexual behavior. QUARTERLY REVIEW OF
BIOLOGY 40:147 – 175 (1965)
• Over the years, animal work accumulated showing
“determining influence” of prenatal hormones
• Money responds to challenge - December 28,
1972
• Symposium of American Association for the
Advancement of Science “Sex Role Learning in
Childhood and Adolescence”
• Man & Woman, Boy & Girl: the differentiation and
dimorphism of gender identity from conception to
maturity. Baltimore, MD: John Hopkins University
Press, 1972. 311 p. (Depts Psychiatry and Pediatrics, John Hopkins Univ. Sch. Med., Baltimore, MD)

23. The David Reimer Story
“Identical Twins Case”
 “Nature-Nurture Experiment”
– Circumcision accident destroyed
John’s penis; Dr. Money consulted
– John is “assigned” as Joan
 Same nature: same genetics, womb
 Different nurturing: raised as different genders
 “Optimal Gender of Rearing” Model
– Touted as a success by John Money, this “Nurture
Over Nature” case report became the foundation
of standard care for treatment of certain intersex
conditions, micropenis, and accidental penile
amputation in infancy

24. Colapinto, John. As Nature Made Him - The Boy Who
Was Raised As A Girl HarperCollins (2000)

25. Joan/Brenda Becomes John/David
 “Joan’s turning point occurred at the age
of 14, when she, on her own initiative,
began living as a boy, John. John recalls
how soon thereafter he finally learned the
truth, “In a tearful episode following
John’s prodding, his father told him of the
history of what had transpired as an infant
and why. John recalls: ‘All of a sudden
everything clicked. For the first time
things made sense and I understood who
and what I was.’”
Beh HG, Diamond M. An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on
Infants with Ambiguous Genitalia? MICHIGAN JOURNAL OF GENDER & LAW 7: 1-63, 2000

26. Colapinto, John. As Nature Made Him -
The Boy Who Was Raised As A Girl
HarperCollins (2000)

27. David Reimer (1965-2004)
 John Money tells medical community that Joan/Brenda is a happy
girl/woman and then claims to lose track of her
 Milton Diamond finds Joan/Brenda living as David!
 When David discovered his case was medically famous and that
thousands of intersex babies had suffered his plight, he cooperated
with Milton Diamond and “went public”
Milton Diamond, Ph.D. & H. Keith Sigmundson, M.D. Sex Reassignment at Birth: A Long Term Review and Clinical Implications. ARCHIVES OF PEDIATRIC &
ADOLESCENT MEDICINE 151:298-304 (1997)
 Money’s view is now discredited!

28. Complete AIS & Gender Identity
39 subjects:
• 100% lived as women and believed that it was the best decision for them; however, this was
not a simple solution for all
• “Acceptance of assignment does not mean that assignment has been correct. It just means that
most are able to adapt and live with the handicap; however, they might have preferred other
options”
published statements from ALIAS, Agree Disagree
an AIS newsletter.
“I don’t think I am any different in 82% 18%
feeling than if I were born XX, feel
very female.”
“All my efforts over the years in 10% 90%
presenting a female persona have
left me completely exhausted. I
might just as well have had a
mastectomy, cut my hair short and
lived as a celibate man. It would
actually have been easier I think.”
I have to “work at being a woman” 56% (dressing in a feminine way 44%
or using cosmetics or hair styles in
a way to signal “female”
unambiguously, altering selection
of clothes;
30% did above much of the time)
Considered suicide 62% 38%
Attempted suicide 23% 77%
Diamond, Milton and Watson, Linda Ann. “Androgen insensitivity syndrome and Klinefelter’s syndrome: sex and gender
considerations” Child Adolesc Psychiatric Clin N Am 13 (2004) 623—640

29. Partial AIS & Gender Identity
18 subjects:
•Often ambivalent about assigned gender
•67% believed that the gender in which they were raised was best for them, whereas the others voiced
reservations
• “Gender switch” occurred at mean age of 33, range 18-46)
PARTIAL AIS
8 raised as boys 4 live as women
10 raised as girls 2 live as men*
Considered suicide 61%
Attempted suicide 17%
*Now angry about castration, vaginal reconstructions surgery, and somatic feminization by estrogen treatment since puberty
**Attempted before switching
Diamond, Milton and Watson, Linda Ann. “Androgen insensitivity syndrome and Klinefelter’s syndrome: sex and gender
considerations” Child Adolesc Psychiatric Clin N Am 13 (2004) 623—640

30. Sexual Identity - Cloacal Exstrophy
 Genetically and
hormonally
male-born
children may
identify as
males despite
being raised as
females and
undergoing
feminizing
genitoplasty at
birth
 Kayla’s story
Reiner, William G. and Gearhart, John P. Discordant
Sexual Identity in Some Genetic Males with
Cloacal Exstrophy Assigned to Female Sex at
Birth. THE NEW ENGLAND JOURNAL OF
MEDICINE, 350:333-341 (2004)

31. The Sexual
Brain
 Amygdala
– Part of Limbic System
– Genesis of emotions
& emotional
expression
 Hypothalamus
– Homeostasis
– Neuroendocrine Control
– Instinctive Drives &
Behavior
 Hunger
 Thirst
 Sleep
 Body Rhythms
 Sex
Netter, Frank H. The CIBA COLLECTION OF MEDICAL
ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy &
Physiology. New York: CIBA (1983)

32. Sexual Behavior Is Controlled by
Anterior Hypothalamus in Mammals
Figure 25-28 Loci where implantations of estrogen in
the hypothalamus affect ovarian weight and sexual
behavior in rats, projected on a sagittal section of
the hypothalamus. The implants that stimulate sex
behavior are located in the suprachiasmatic area
above the optic chiasm (blue area), whereas
ovarian atrophy is produced by implants in the
arcuate nucleus and surrounding ventral
hypothalamus (red). MB, mamillary body

33. Bed Nucleus of the Stria Terminalis
Figure 2: Representative sections of the BSTc innervated by vasoactive intestinal polypeptide (VIP).
A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual.
Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized
medial subdivision (BSTm), and large oval-sized central subdivision (BSTc)
Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)

34.  Representative
Somatostatin
immunocytochemical
stainings of the somatostatin
Results Parallel
neurons and fibers in the
BSTc
VIP Results
– (a) a reference man
– (b) reference woman
– (c) homosexual man
– (d) male-to-female transsexual
 Note the sex difference
regardless of sexual
orientation
 The male-to-female
transsexual has a BSTc in the
female range
Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G
And Swaab, Dick F. Male-To-Female Transsexuals Have Female Neuron Numbers In A
Limbic Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)

35. Summary -
Core
Sexuality
 The scientific story explains everyone!
 “The preponderance of evidence seems to
indicate that the theory of organization-
activation for the development of sexual
behavior is certain for non-human mammals
and almost certain for humans“
Milton Diamond. Clinical implications of the organizational and activational effects of hormones. HORMONES AND BEHAVIOR 55:621–632 (2009)
LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70
(1995)
Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G And Swaab, Dick F. Male-To-Female Transsexuals Have
Female Neuron Numbers In A Limbic Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)
Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2,
2008)

36. Organization-Activation Theory
“The fetal brain develops during the
intrauterine period in the male direction
through a direct action of testosterone on
the developing nerve cells, or in the
female direction through the absence of
this hormone surge. In this way, our
gender identity (the conviction of
belonging to the male or female gender)
and sexual orientation are programmed or
organized into our brain structures when
we are still in the womb”
Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC
NEUROENDOCRINOLOGY 17: 22-35 (2010)

37. Critical Periods of Genitalia
and Brain Are Different
 “However, since sexual differentiation of the
genitals takes place in the first two months of
pregnancy and sexual differentiation of the brain
starts in the second half of pregnancy, these
two processes can be influenced independently,
which may result in extreme cases in
transsexuality.”
 “This also means that in the event of ambiguous
sex at birth, the degree of masculinization of the
genitals may not reflect the degree of
masculinization of the brain.”
Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC
NEUROENDOCRINOLOGY 17: 22-35 (2010)

38. Core Sexuality:
Nature - Not Nurture!
 “There is no indication that social
environment after birth has an effect
on gender identity or sexual
orientation”
Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC
NEUROENDOCRINOLOGY 17: 22-35 (2010)

39. We Don’t Learn Our Sexuality.
We Discover It!
Sexual Identity,
Sexual Orientation,
and Sexual Anatomy
Can Be In Any Combination.

40. Three  Somatic Morphology (X axis)
Dimensions of  Sexual Identity (Y axis)
Core Sexuality  Sexual Orientation (Z axis)
Gynecentric
Androphilic
Gynemorphic Andromorphic
Everyone occupies a
Gynephilic point in this three-
dimensional space!
Androcentric

41. Sex ≠ Gender
 Sex is biological
 Gender is cultural
 Gender “traits” differ
from culture to culture
and from time to time Castor Semenya
Controversy over whether this
South African eighteen-year old
should be allowed to compete
as a woman continues

42. The “Gender Binary”
 We live in a “binary gendered” culture with two
genders only
– Woman
– Man
 Many cultures recognize more than two genders

43. Disordered or Just Different?
 Gender binary has permeated medicine
 The medical profession has
pathologized and stigmatized gender-
variant peoples
– Lesbian, gay, bisexual people
– Transsexual people
– Intersex people

44. Medical Profession’s Treatment of LGBT People
1952 (DSM-I) Sociopathic Personality Disorders
1968 (DSM-II) Sexual Deviation
1970 Gay rights activists storm APA annual convention
1972 APA annual meeting –first-ever panel of non-
patient homosexuals” and Dr. Anonymous
1973 (DSM-II Revision) Deletion of Homosexuality
Substitution of Sexual Orientation Disturbance
(Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is
an illness)
1980 (DSM-III) Gender Identity Disorder (GID)
Ego-dystonic Homosexuality (formerly SOD)
1987 (DSM-III Revision) Homosexuality omitted entirely
(Ego-dystonic homosexuality/SOD removed. It’s normal to not want to be persecuted & empirical
data to support diagnosis is lacking))→
2000 (APA Position Statement) Ethical psychiatrists should stop conversion or
“reparative therapies”
Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990

45. Medical Quackery Continues
 Genital normalization surgeries on
newborns continue!
 DSD = Disorders of Sexual Development
 OII objects to “disorder” terminology
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
 Milton Diamond recommends
“Differences” or “Variations” of Sex
Development
http://adc.bmj.com/content/91/7/554/reply#archdischild_el_2460?sid=437e97e7-049d-42c8-b60f-6d8d02dd31c1
http://adc.bmjjournals.com/cgi/eletters/91/7/554

46. Intersex Problems
Are Socio-cultural
 “The basic problems faced by the
intersexed are socio-cultural in nature
and not medical and are a result of the
dogmatic fundamentalism inherent in
the current binary construct of sex and
gender”
 “Some intersexed individuals are
subjected to genital mutilation in
childhood as a result of this
totalitarian, sexist oppression” Curtis Hinkle - Founder
Organization Intersex International
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html

47. Different but Not Disordered
 “Around the world intersex individuals are being
subjected to inhumane and degrading altering
surgical and hormonal procedures, without
consent of the intersex person, at the discretion
of doctors and outside legal regulation.
This is done to “normalize” genitals and bodies in
order to fit intersex people within the sex binary
of men and women.
Pathologization of intersex individuals results in
gross human rights violations and abuse of
bodily integrity
and personal dignity.”
1st International Intersex Forum, Brussels, Sept. 3-5, 2011

48. Phall-O-Meter
Sharon E. Preves. INTERSEX and IDENTITY The Contested Self Rutgers University Press (2003)
 Whatever happened to “informed consent?”
 Whatever happened to “first, do no harm?”

49. Genital “Normalization” Surgery - Dismal Outcomes
 23% of participants (46XY, Quigley grade 2-4, average 3.5, roughly half were assigned/raised as
boys, half as girls) were dissatisfied with sex of rearing
– Indicating “general predictions cannot guarantee future
gender development for any single case”
– This figure could be as high as 44%
(if all non-participating patients were also dissatisfied)
 Majority (62% men, 67% women) sought counseling
concerning condition
 Mean surgeries: men 5.8; women 2.1
 Half were dissatisfied with body image
 Two-thirds were dissatisfied to some degree with
sexual function
 Researchers never asked: What if we did nothing?
Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With
Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)

50. NEW STANDARDS OF CARE American Academy British Association Pediatric
FOR Pediatricians Surgeons
INTERSEX PATIENTS year 2000 year 2001
Diamond, M. Sex, gender, and identity over the years: a changing
perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS
OF NORTH AMERICA 13:591-607 (2004) No surgical moratorium
#1. General moratorium on sex (In1999, AAP decided that surgical
moratorium was “unrealistic” because it No surgical moratorium
assignment cosmetic surgery was hypothesized that parents would not
accept it)
#2. Moratorium should not be Recognized need for more Recognized need for more
lifted unless and until studies research and greater candor research and greater candor
show outcomes are positive and honesty and honesty
#3. Efforts should be made to No call back to families or No call back to families or
undo effects of past physician individuals that had previous individuals that had previous
deception and secrecy treatment treatment
Informed consent includes
Response to intersex birth “Social emergency” “possibility of non-operative
management”
All virilized females (CAH or
Gender assignment on
maternal androgen) should be
Gender assignment individual basis; may include
girls (because of retained
cultural considerations
fertility)
Infants raised as girls “will “There is a strong case for no
Clitoral surgery usually require clitoral clitoral surgery in lesser
reduction” degrees of clitoromegaly”
PAIS infants “in whom a very
small phallus mandates a The risk of malignant testicular
Penile surgery
female sex of rearing” should changes in AIS is small
have testes removed

51. Pediatric Policy Is Reprehensible
 2006 Consensus Statement - chose term
“Disorders of Sexual Development”
– Dismiss “sexual identity” issue
 “Structure of the brain is not currently useful for gender
assignment”
 Factors they say influence their decision on gender
assignment
– Diagnosis
– Genital appearance
– Surgical options
– Need for lifelong replacement therapy
– Potential for fertility
– Views of family
– Circumstances relating to cultural practices
Collaboration with participants in International Consensus Conference on Intersex organized by Lawson Pediatric Endocrine Society and European Society for Paediatric Endocrinology
Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)

52. Pediatric Policy Must Change
 Pediatricians use parental distress & prejudice to
justify damaging surgery
Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
 Clitoral reduction is “standard clinical procedure”
(Dr. Dix P. Poppas, Panel at Weill Cornell Medical College)
http://www.cornellsun.com/section/news/content/2010/10/05/weill-medical-college-
says-poppas%E2%80%99-surgical-procedure-standard
 Pregnant women treated with dexamethasone to
prevent “behavioral masculinization” (same-sex
attraction and tom-boy behavior) in CAH girls
http://www.starobserver.com.au/news/2010/07/15/opposition-to-genital-drugs/27947
Meyer-Bahlburg HF, Dolezal C, Baker SE, New MI. “Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of
Degree of Prenatal Androgen Excess” ARCHIVES OF SEXUAL BEHAVIOR 1: 85-99 (2008),
 Let’s follow Columbia’s example
Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004)
 Europe has ethical principles for intersex treatment
Wiesemann, C., Ude-Koeller, S., Sinnecker, G. H. G., & Thyen, U. Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex
in children and adolescents EUR J PEDIATR 169:671–679 (2010)

53. Poor Medical Treatment
of Intersex People
 Over 50% are
misdiagnosed!
Minto CL, Crouch NS, Conway GS, Creighton SM. XY females: revisiting the diagnosis BJOG:
an International Journal of Obstetrics and Gynaecology 112:1407–1410 (2005)
 Intersex people have
their own physiology
and health concerns
that are not being
addressed by
physicians
Holterhus P-M, Bebermeier J-H, Werner R, Demeter J, Richter-Unruh A, Cario G, Appari M,
Siebert R, Riepe F, Brooks JD, Hiort O. Disorders of sex development expose
transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in
human blood leukocytes BMC GENOMICS 10:292 (2009)

54. Intersex People Now Also Crazy!
 Special subtype of gender incongruence in
DSD is recommended by Zucker’s
committee for the DSM-V!
 OII responds: “We see no need to further
medicalise and stigmatize intersex people
by referring to them as necessarily
disordered (DSD) and where mistakes in
assignment have been made, we see no
value in medicalising and stigmatizing them
further by applying another form of disorder
called ‘gender incongruence’”
http://www.intersxualite.org/DSM5.html

55. Germany Is Leading The Way
To Ethical Medical Treatment Of
Intersex People
 Historic public consultation and dialog on intersex
– Intersex people in Germany were invited to participate and observe proceedings in an
historic public consultation and dialog “on the situation of people with intersexuality
[sic] in Germany”. The event has been organized by Deutscher Ethikrat - The German
Ethics Council – and its participants include ‘experts’ in intersex, medical people,
lawyers, parents of intersex people and some intersex people themselves. June 6th,
2011
http://oiiaustralia.com/13790/intersex-people-germany-experts-deutscher-ethikrat-consultatio/
 Ethical principles and recommendations for the
medical management of differences of sex
development (DSD)/intersex in children and
adolescents
– “…the psychological and social support of the child and its parents is to be
ranked higher than the creation of biological normalcy.”
– “…Whenever prognostically uncertain interventions can be delayed until the
child is old enough to make decision for themselves, this option should be
presented to parents as the preference of choice.”
Wiesemann C, Ude-Koeller S, Sinnecker GHG, Thyen U. Ethical principles and recommendations for the medical management of differences of sex
development (DSD)/intersex in children and adolescents EUR J PEDIATR 169:671-679 (2010) DOI 10.1007/s00431-009-1086-x

56. Common Concerns - LGBT and I
 Not “Adams” or “Eves.” Do not fit the “gender
binary”
 Stigmatized as “disordered” (rather than “different”)
 Cruel and unnecessary medical “treatments” – based on
belief in “gender binary” and that sexual behavior is
learned
 Real medical needs not met by medical profession
 “In the closet” (secrecy & shame)
 Must “come out” and find each other
 Need to politically organize to obtain their human rights
 Civil rights issues based on gender expression
 Many intersex people share “sex reassignment” issues
with trans people
 Transsexuality is a subtype of (brain) intersex

57. Discrimination Against Intersex
People Is a Socio-cultural Disorder
 Intersex people are natural variations
 Intersex people are different, not
disordered
 The suffering of intersex people is not
intrinsic to their condition; rather it is
imposed by the binary-gendered society/
culture

58. Intersex People Forsaken by
Religion and Medicine
 Organized religion and the medical
profession have been part of the socio-
cultural problem and continue to be a
problem
 The scientific message that “core
sexuality is innate” needs to reach the
religious communities, medical
community, educators, and parents

59. Human Rights Issue:
To Be Who We Are
 Respect diversity!
 People should be able to express
themselves wherever they feel
comfortable on the feminine-masculine
continuum without having rights taken
away or medical alterations forced upon
them to maintain those rights
 All of us, not just the Adams and the
Eves, have the birthright to be who we
naturally and innately are

60. Basic Human Right:
To Be Who We Are!