Queer | Feminist | Doctor

So I’ve spent quite a lot of today attempting to discuss gender with people who are convinced that transsexual women are (despite the name) actually men. I’m not going to reproduce their arguments here as they are upsetting for many and triggering for some, so I’m just going to explain my views on sex and gender and what evidence they’re backed up by.

There will be some descriptions of medical syndromes including intersex conditions, but I will do my utmost to keep it simple.

If you’re interested in a more in-depth examination of biological sex as a social construct I highly recommend “Hermaphrodites and the medical invention of sex, by Alice Domurat Dreger”. I read it while working with Professor Sarah Creighton, a gynaecologist whose area of expertise is adolescent and adult women with disorders of sexual differentiation.

Those six weeks changed my life in more ways than one, but it is the gender and sex stuff I’ll be discussing here!

Full disclosure: I am a medical doctor, and identify as both trans and genderqueer, and am undergoing a gender transition which may include hormone and/or surgical treatment. If that information is enough to make you reject anything I have to say on gender and sex, then I guess I just saved you the bother of reading the rest of the blog post.

But I hope, like any good scientist, that you are interested in learning about the evidence, and letting that challenge your views!

What do people mean when they say “biological sex”?

On the surface of it it seems like quite a simple thing – are you male or female? But, like many aspects of biology, it is more complicated than it seems at first glance. Over the past 150 years or so, scientists (mostly highly privileged men, let’s be honest), have been trying to figure out what determines someone’s “true” sex, and as more discoveries have been made about how the human body works, our ideas of what “true sex” or “biological sex” means have changed.

Usually, now (2015), people mean whether you’re male or female, or as I’ve been asked “are you a boy or a girl?” It is usual when a baby is born to ask “boy or girl?” and a LOT of baby stuff (congratulations cards/balloons, clothes, toys) are made in pink for girls, blue for boys, and not many other options are available!

When a baby is born we look at the external genitalia to see whether the baby is “boy or girl”, but in many cases it is impossible to tell! For a number of reasons, a girl may be born with what looks like a penis and even a scrotum (this is called “virilisation” and “ambiguous genitalia” in medical practice). Or a boy may be born with a tiny penis that looks more like a clitoris.

When someone isn’t clearly male or female we call them “intersex” – and there are intersex conditions that show up at birth, and those which aren’t revealed until later life, often at puberty. It is estimated that as many as 1 in 1500 children are born with an intersex condition or “disorder of sexual differentiation”, although some are very mild.

Historically, it used to be  said that people who were attracted to women must be men, and vice versa. This seems like a ridiculous view seen from a modern perspective – now that we understand that sexual attraction, or sexuality, is not the same as gender (how you feel) or sex (what your body looks like).

Then, as science progressed and different biological features were discovered, it was said that your hormones were what made you male or female, or what appearance the cells of your gonads (testes, ovaries, or occasionally something inbetween) had under microscope. Chromosomes were discovered, giving us another way to try to find out someone’s “true sex”.

But the fact is, no one of these features can be used to tell whether someone is male, female, or intersex. It’s true that MOST women are born with a clitoris, vagina, uterus, fallopian tubes, and ovaries, have low testosterone and high oestrogen and progesterone, and have XX chromosomes.

But there are some women who are born without a vagina (vaginal atresia, which can be caused by Mayer-Rokitansky-Küster-Hauser syndrome, and complete androgen insensitivity), some women who are born with XY chromosomes (complete androgen insensitivity), some women who are born with genitals that look somewhat, or completely  like a penis (this can be caused by congenital adrenal hyperplasia for example). There are some women who have a high level of testosterone (for example in cystic ovarian syndrome).

In truth, it looks like there isn’t such a thing as someone’s “true sex” – rather than being a binary that you can measure from a single test, it is a spectrum, made up of a number of different characteristics, including hormone levels, reproductive tract, chromosomes etc.

I often hear people proclaiming that they are “XX” or “XY” but I wonder how many of them have had their chromosomes tested? There are people in the world who have intersex conditions that they’re not aware of, although some of this is because intersex conditions have been so stigmatised that the truth was hidden from them as children, and they have grown up without this important knowledge.

More recently, brain scanning has been used to try to figure out what gives someone a “female brain” or a “male brain” – some early differences were touted as being “the answer” to why some people have a “male body” but feel that they are a woman, or vice versa.

Some of these papers showed similarities between a cis woman’s brain, and a trans woman’s brain, even without any hormone treatment muddying the waters. Other papers were less certain of the differences.

One review paper concluded, surprisingly enough, that while there were characteristics share by men’s and women’s brains, there isn’t such a thing as a “true female brain” or a “true male brain” – just like with the rest of the body.

When it comes to biological sex, you can categorise yourself and others by how many of the boxes they tick from either the “male” or “female” list – but if you try to predict someone’s sex from just one of those characteristics, you aren’t going to be right every time. T

his relates to trans men and women, because some radical feminists (called trans-exclusionary radical feminists, although apparently some prefer the term radical feminist separatists) think that trans women aren’t “really” women, and that trans men aren’t “really” men – and the arguments they use usually related to biology and the idea of “true sex”.

I’ve written this post to show that like gender, “biological sex” is an idea that only exists because society agrees that it does – which is not to say that it does NOT exist, but that the idea of what it is is socially determined, and not based in “biological fact”.

For a comprehensive explanation of sex-related brain differences in relation to gender identity, you may find this article useful, although it does get somewhat technical at points: http://www.shb-info.org/sexbrain.html


Comments on: "What does “biological sex” really mean?" (4)

  1. Michael Bell said:

    I think you’ve shown a real lack of understanding here. You’re using statistical anomalies to make a general statement. Saying biological sex is a social construct because a statistically negligent number of people are born of indeterminate sex, is like saying that humans aren’t bipedal because some people are born with only one leg.

    The fact that you are a doctor gives me some serious concern.

    • As many as 1 in 1500 people are born with an intersex condition. It isn’t a negligible number (I’m assuming you meant negligible rather than negligent, as a negligent number isn’t a thing as far as I know).

      Biological sex is socially constructed – it used to be that anyone who was attracted to men was determined by the scientists of the day to be a woman.

  2. So, hello again from Twitter.

    ‘ it used to be that anyone who was attracted to men was determined by the scientists of the day to be a woman’

    What are you thinking of here? I’m not aware of this. What period are you talking about?

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