Science vs Activism in Biological Gender Ambiguity

A small percentage of live births involve genetically-based gender ambiguity. What is the ethical response?

They’re called DSDs: disorders of sexual development. They are rare, but they are real. We’re not talking about grown people deciding one day to “identify” with the opposite sex despite clear evidence to the contrary. No; there are a very few children born with a “micropenis” or enlarged clitoris that seem to share traits of both sexes. Why not just look for a Y chromosome? Trouble is, some XY children have a genetic mutation that switches off an key gene named SRY that controls development of male traits, while some with XX children express abnormal amounts of testosterone. Then there “males” with an XXY genome.

While the vast majority of children are clearly identifiable as male or female, there are a tiny fraction facing these biological challenges. Uncomfortable as it is for many to talk about this, the LGBT activists are driving the issue to the forefront, trying to legitimize the notion that gender is a spectrum with a biological basis. That’s an unwarranted extrapolation; the exceptions prove the rule, not the other way around. Nevertheless, children born with DSDs, along with their parents and doctors, need to know what to do. Policy issues reach all the way to the International Olympic Committee, which is revising 2011 standards about whether those who “identify” as females can compete against other women.

Sara Reardon in Nature News this week explores the emotional and philosophical challenges of DSDs. She claims:

DSDs occur in an estimated 1–2% of live births, and hundreds of genital surgeries are performed on infants around the world every year. But there are no estimates as to how often a child’s surgically assigned sex ends up different from the gender they come to identify with.

The numbers depend on how one defines a DSD. The term covers a whole range of conditions. Since sexuality develops in the embryo over time, some cases may involve “late bloomers” trending toward their gender later than usual. This is not surprising, since everyone knows that secondary sexual characteristics develop at puberty over a decade after birth when certain hormones kick in. Even in adulthood, individual men and women exhibit ranges of masculinity and femininity; that does not imply that they fall into wholly different categories of gender. Quoting a number like 1-2%, as if a snapshot at birth is the final word, may be an overstatement; children with apparently ambiguous genitalia may develop normally later as hormones continue their expression. A BBC article puts the incidence at 1 in 1,500, an order of magnitude lower than Reardon’s number. This page by the “Intersex Society of North America” breaks down the 1% figure into categories. The number with genetic abnormalities is closer to one in a thousand; those with “complete genital dysgenesis” is 1 in 150,000. Exact figures are hard to come by (see this NIH paper about attempts to classify DSDs, and another one from Korea that puts the overall incidence of DSDs at 1 in 5,500).

Reardon centers her story about the work of medical doctor Eric Vilain, one of the few geneticists and medical doctors trying to get to the biological basis behind these disorders and help children affected by them. He is not a villain except to certain polarized extremists; Reardon portrays him as a fair-minded scientist who just wants to understand the phenomenon by collecting data on DSD children in longitudinal studies. Because he doesn’t jump on LGBT activist bandwagons, he gets flak. “The thing I don’t want to compromise is scientific integrity, even when it clashes with the community narrative,” he says.

One of the things Vilain gets flak over is his refusal to categorically denounce surgical restoration of children. For decades, the standard medical practice has been surgical restoration toward one or the other sex. Having worked with many families facing this challenge, Vilain thinks parents have a voice in the decision. This runs afoul of the growing intolerance by LGBT activists for anyone who denies each individual their own choice about what gender to identify with. Vilain, for his part, “doesn’t generally recommend surgery,” Reardon says.

But he and his collaborators on the longitudinal study are reluctant to condemn surgery outright — they prefer to approach each case individually and to consider the views of parents who may feel strongly about what is right for their child.

This attitude helped to create the rift between the researchers and intersex advocates….

Vilain and colleagues are trying to keep the conversation focused on hard data, but “things are getting uncomfortable for him” in the current political climate. With the feds threatening cutoff of over a billion dollars to North Carolina for its law requiring state-run institutions (not private companies, who can make their own choices) to have people use the bathroom that corresponds with the sex stated on their birth certificates, the tense political situation is forcing doctors like Vilain into the spotlight. (Hear Family Research Council “Washington Watch” broadcasts for May 10 and 11 about the developing standoff in North Carolina; the governor sued the Feds, and the Feds have now sued back!)

Activists demand that his science support their agenda, but his experience does not show that children operated on are generally worse off physically or psychologically. The few that have problems as adults make more noise than the majority of well-adjusted adults who go on with their lives. Without surgery, children can face severe embarrassment among their peers. Activists want him to condemn all surgery outright, but Vilain cautions, “Good ethics requires good data.” He is also concerned for parents; do they not have a voice? International pressure is making his rational search for good data difficult.

In January, the United Nations released a report saying that sex-assignment surgeries on infants “lead to severe and life-long physical and mental pain and suffering and can amount to torture and ill-treatment”. Vilain and [David] Sandberg [Univ. of Michigan, also working on data collection] worry that the language could alienate doctors and parents alike. “You’re basically calling doctors torturers when they’re doing something considered standard medical practice,” Vilain says. He points out that few medical procedures are governed by law — physicians tend to operate according to guidelines and principles. “I‘m not opposed to guidelines, I’m opposed to things that completely alter medical practice in an irreversible way,” he says. He and Sandberg also worry that legal bans could drive infant surgery underground. “Parents are scared. You just don’t dictate to them and say get over it,” Sandberg says.

Vilain has also been dragged into the Olympics controversy. He admits that a testosterone threshold provides insufficient justification for those XY genotypes who identify as women to be allowed to compete in women’s events, but the science just isn’t there yet to support the LGBT activists’ demands, he claims. Reardon says he’s not trying to antagonize anyone:

Yet Vilain’s experiences with patient advocates have hardened him somewhat. “I call the ones who work with us advocates; those against us activists,” he says. He remains driven by questions about sex, even if it kicks up dust. “We’re trying to listen to the community, but by the same token we’re committed to producing data and evidence.”

This contrasts with the response of psychiatrist Robert Spitzer, whose capitulation to gay activists in 1973 gave them a weapon to use against anyone opposing their agenda (see 1/10/16). Activists today are not content to let parents and doctors decide. They want to blur gender distinctions entirely. Given the political hot potato, how long will Vilain be allowed to keep his “just the facts” approach?

Bathroom Policies

Stephanie Pappas on Live Science describes “the weird history of gender-segregated bathrooms,” claiming that separate bathrooms are a recent invention. Actually, cultures rarely had free-for-alls when it came to obeying nature’s call. There were other ways people managed discretion and privacy, especially women, as Pappas shows. Even today, most small operations, including small businesses and airlines, provide unisex bathrooms to be used one person at a time. Since the vast majority of people have no problem identifying as men or women, Tony Perkins of Family Research Council offers a compromise; his, hers, and “other” for the very few needing accommodation.

We are trying to be scientifically sound about this politically hot topic. Every human being deserves respect as a creature made in the image of God. In the beginning, as Christians and Jews affirm, there were only two sexes: “In the image of God he created him; male and female he created them.” That is the foundation for understanding human sexuality. God ordained two–and only two–sexes, that unite to procreate and form the family unit. A very few have a real biological basis for failing to fall into clear male/female categories due to genetic mutations (a consequence of the Fall). They deserve the same respect and understanding anyone with a genetic disorder deserves.

That does not mean, however, that the whole society has to toss out millennia of tradition about male-female differences to accommodate a tiny percentage of affected individuals, especially when the majority of those, with proper treatment or surgery, grow to comfortably identify with one sex or the other on their own. (For the few of those that continue to have biological ambiguity issues, there is sex change surgery as an option.) Society does not have to invent something new: a third gender, a fourth, an n-th gender, or come up with new words and pronouns with which to refer to them. The Judeo-Christian ethic would be to compassionately help steer children toward the sex God ordained for them, as best can be determined.

It’s just like government bureacrats to insert their power into matters that never were a huge problem before. The current administration’s Justice Department (how’s that for an Orwellian term) appears to be on a campaign to force all bathrooms in the country to be open to everyone. If they succeed, that campaign will not be satisfied till every locker room and shower is “gender neutral,” to the horror of little girls seeing grown men naked in their most vulnerable moments. Where is the protection for the majority? It’s similar to the TSA demanding every airline passenger be subjected to an intrusive body scanner producing nearly-nude imagery (for who-knows-what TSA voyeur) or else be subjected to an invasive pat-down, just because a tiny minority of terrorists cannot be “profiled” out of “political correctness” (another Orwellian term).

Society can help a few individuals with legitimate genetic issues without turning the world upside down and hurting everybody. Accommodation is an American tradition. But already, there have been incidents of male voyeurs invading girls’ bathrooms and taking pictures of women on the claim they “identify” as female. We can expect more atrocities if this trend continues. Maybe 0.4% of the population is so-called “transgender.” It’s not enough to love them and accommodate their needs. No! Everyone must celebrate them and call them normal! To keep from hurting their feelings, everyone must suffer! Everyone’s privacy and security must be compromised! If you complain, we will call you a bigot! Do you need any more evidence that leftist liberalism is a form of mental illness?

“If you can keep your head when all about you are losing theirs and blaming it on you…. you’ll be a Man, my son!” —Rudyard Kipling