Tuesday, March 27, 2012

"You Know What That Is!"

I had an interesting interaction with a colleague today. As a vegan, I get lots of questions about, "But what about free-range animals?" or "But what about if you know the farm?" or "But what if you were on the desert island and the only thing on it was cheese?" and so on and so on. Today I got a question about eggs.

This devolved into a lateral conversation about how this colleague has interacted with individuals who felt strange about eating eggs because they described them as "baby chickens" - something that is absolutely not true if the eggs are not fertilized. (Even if they are, I think it is worth considering whether these embryos are actually "baby chickens," but this is a completely different issue that won't be discussed here.)

My colleague laughed about this, emphatically saying, "No! Unfertilized eggs are not baby chickens! I mean, when indiviudals have their period, they're just releasing an egg - that's it! I mean, you do that - you know that!"

I smiled, and said, "Uh, yes, I do know that, but yeah, I actually don't do that." She smiled, and said, "Ohhh, right." To which I raised my leg and pumped my fist, and said, "Yes! Beating nature again, ha ha!" And we both laughed.

I obviously am not "beating nature." My body IS natural. It is a legitimate variation as to what bodies can look and function like. But the fact that I am exclusively regarded as a female operating in the world, and yet my body doesn't do this menstruation thing everyone assumes it does, is a good opportunity to make a lighthearted joke to validate the existence of intersex bodies. It was a simple, good moment, where I felt my intersex identity validated in a really casual, no-need-to-explain it way that felt natural and good. I hope to have more moments like this in the future. :)

Compelling Statistics on The Number of Intersex Individuals

Hi, everyone! I have previously posted that it's difficult to determine how many intersex individuals there are for a variety of reasons. One reason is that long-term studies of intersex individuals are not being done so that more accurate censuses can be taken. A lot of this is logistical, since in order to do this, patients would need to be contacted, and many clinicians are reluctant to give others access to their clinical files (for example, in case (former) patients or outside agencies decide to legal action against them later based on information seen in these files). Additionally, many patients may not be interested in responding if they do not actually identify as intersex. They may identify as a male or female who happens to be intersex, or they may identify as just male or female, and intersex has little to no impact on their sex identities.

A recent post by Dr. Cary Gabriel Costello, of the blog Intersex Roadshow, makes a strong case that the frequency of intersex individuals - colloquially stated as being as common as 1 in 2000 births in the United States - is a vast underestimate. Costello compellingly shows that the number of intersex individuals is not 1 in 2000 (still a pretty sizable number on its own), but actually more than 1 in 150. In order to make these nubmers accessible, activists have stated that 1 in 2000 is a statistic that approximates the frequency of individuals with red hair. Red hair is not overwhelmingly common, but many people know an individual with red hair, and would not find it strange to encounter an individual with red hair. Red hair is not rare. If we don't think that having red hair is shockingly strange, then maybe we should accept that intersex individuals' existence isn't so strange, either. However, Costello's statistic of 1 in 150 approximates the frequency of individuals with green eyes. If red hair is not considered shockingly uncommon, then seeing a person with green eyes is absolutely unremarkable for most people. If there are as many intersex individuals as there are individuals with green eyes out there, that is a LOT of people!

It's important to note that regardless how common intersex individuals are - even if intersex individuals were as common as 1 in 2 billion - it doesn't justify the alteration or manipulation of intersex individuals' bodies without our consent when these practices don't serve to track our health. However, it arguably provides more of an emotional impact to think that intersex is not so uncommon as we think. These non-consensual medical "treatments" aren't happening to like, 1 in every certain unfathomably large number of kids - a number so large it seems that almost no one has to go through this, and thus many individuals might find it less worthwhile to fight so hard to recognize intersex individuals exist and end these practices that pretty much never happen. These practices are happening to LOTS of kids out there. Understanding how common intersex really is, and considering the sheer number of lives are affected through non-consensual treatment to "fix" intersex, is really sobering.

I'm going to be thinking about this for a while. What do YOU think about this?

Monday, March 19, 2012

Cisgender and AIS

Hi, there, everyone! A while ago, Queer Intersects posted some ideas about the link between AIS (androgen insensitivity) - my own form of intersex - and cisgender. Cisgender can be broadly defined as identifying that your body form "matches up" with your gender identity. For example, "I am a biological female and I feel like a female! I am a cis-gender female." This term is often used in contrast to transgender, which can be defined as identifying that your body form does not match up with your gender identity. For example, "I was assigned male at birth, but I am a female! I am a female, who happens to be transgender." Other examples may include those who identify as genderqueer, where their biological sex does not necessarily match up with their gender identity, and/or their gender identity may not be either male or female. For example, "I was assigned female at birth, but I [do not identify as male or female] [identify as male or female some of the time] [identify as genderless] [do not use any labels to describe my gender]." There is a lot of variation in what it can mean to be transgender.

Before talking more about cis-gender, let's define AIS. AIS, or androgen insensitivity - is my own form of intersex. There are two main forms of AIS - CAIS (complete androgen insensitivity) and PAIS (partial androgen insensitivity). It's important to note, though, that there's not just two kinds of AIS; within each of these two broader categories, there are many variations within of how one's body may function and look. One of the hallmarks of AIS individuals, in general, is that they "look feminine" because they are adrogen insensitive to some degree (= their bodies cannot use testosterone at all (CAIS), or their bodies can use testosterone to some extent (PAIS)). Although some clinical literature states that AIS bodies may be "hyperfeminine," this concept has been challenged by Queer Intersects about what it means to be and look feminine in the first place. AIS bodies may be be albe to be accurately characterized as hyperfeminine, but regardless, AIS individuals walking down the street would not be labeled "male" by other passers-by by virtue of their intersex.

Why is this information about AIS relevant here? Weren't we going to talk about identity and cis-gender? We definitely are! This information is relevant because intersex indviduals may tend to have body features that result in others reading them as more masculine or more feminine, depending on their form of intersex. (Any individual - intersex or not - may look more masculine or feminine anyway, based on individual differences, but this isn't what we're referring to here.) Individuals with AIS variations happen to conform to stereoteypical ideas about what women look like, so they are almost alway regarded as exclusively female. Since most mainstream societies assume a link between biological sex and gender identity, AIS individuals are labeled as cis-gender females, even if passers-by on the street don't exactly use that terminology. (They'd be more likely to go, "Oh, look! A woman.").

While cisgender sounds relatively straightforward, things become more complex when considering AIS. Are AIS individuals actually cis-gender? Can an individual be both cis-gender and intersex? If you identify as intersex, does that inherently mean you cannot be cis-gender? What happens when others label you as cis-gender, but you don't feel like you are?

One thing to consider is that identity comes from different places. Self-identity and perceived identity by others are different phenomena. For example, I self-identify as intersex but am never identified as anything other than cis- female by others, unless those people know them me and are aware of my intersex identity. Since I'm read as cis-female, though, does this cancel out my self-identity? Is my intersex identity less real? No, it doesn't mean that it's less real; it simply means that there is sometimes a discontinuity between self-identities and perceived identies. If perceived identities are incorrect (= others assume you are someone you're not), it doesn't mean that one's self identity is less real, although it complicates communicating who you are since intersex is still largely misundertood or unheard of. If self-identity is about knowing who you are, then perceived identity is about visibility. AIS individuals who identify as intersex may feel uncomfortable being perceived since their intersex identity is not visibile. The fact that intersex is stgmatized, and discussing intersex in a meaningful way is uncommon, does not make it easier to clarify such situations by communicating one's intersex identity.

It is also worth nothing that identities may not be static, but fluid. Identities may shift over short or long periods of time - for example, over the course of minutes, hours, days, weeks, months, years, decades, etc. Individuals that have a fluid sex and/or gender identity - whether on a frequent basis, or a one-time event - may also feel dissonance between their self-identities and perceived identities if they feel that their self-identity has changed over time and their perceived identity has not, or vice versa, or if both fluctuate.

Another interesting point in sussing out the relationship between cis-gender and intersex is that whether one identifies as cis-gender or not, AIS individuals still receive cis- privilege by virtue of being read as cis-gender. Some intersex individuals may variably be read as either male or female by others; some people may feel uncomfortable and verbally or physically assult individuals they feel are not easily labeled as "male" or "female." AIS individuals are not subject to this kind of discrimination since they are almost always identified as "female," and thus don't any difficulty in being labeled male or female by others because of their intersex. Going further, the relationship between intersex and the cocnept of cis-gender itself merits scrutiny. While Queer Intersects points out the difficulty in finding clear-cut, inclusive definitions of what "cis" really is, the concept of cis-gender is really simplified in thinking that it's when your body "matches up" with your gender identity - i.e., "I identify as female and I'm female-bodied"; "I identify as male and I'm male-bodied." (Of course, this assumes that sex and gender identities need to "match up" in a certain way, which is not the case. You are who say you are! Period.) Accounting for intersex bodies, it becomes clear that biological sex is not binary - there are many variations. If we agree that intersex bodies exist legimately in their own right, and aren't "in between" or "ambiguous" with regard to male and female forms, then the concept of "opposite" doesn't make sense. For an individual who identifies as intersex, what would the opposite be? What would the not-opposite look like? Is the concept of your-identities-don't-need-to-match-up-in-a-particular-way-to-be-valid relevant here? is that I need think more about this.

Part of me thinks that if we embraced the fact that there are not only two kinds of biological sex - male and feamle - then the utility using the terms cisgender and transgender would break down. If we accepted that there aren't just two kinds of sex, describing one's gender as the "same as" or "opposite" one's sex cease to be meaningful. However, this line of thought assumes that individuals that could be included as intersex individuals actually identify as intersex - something that is not necessarily the case. Individuals may identify as males or females, who happen to be intersex, for instance. They acknowledge that they are intersex, but it's not a part of their IDENTITY. In these cases, using terms like cis- and trans- may be more useful in describing their identity.


Intersex identities make it clear that the concept of cis-gender, and its use as an identity label, is much more complex that it may initially seem. Here, we've got several different viewpoints that may contradict one another in various ways. It may be tempting to conclude that there's no answer to how intersex and cis-gender relate, but I think that the answer is that this issue is complex and a diversity of thought exists about these concepts. The answer is that things are really messy, and more discussion is necessary to clarify the relationship between intersex and cis-gender. Answers don't = easy answers, for sure. What do you think?

Out of the Grey, Off of the Spectrum

Hi, there, all of you! How is your day going? :)

I have been starting to read and watch more intersex books and films, in order to educate myself about what intersex resources are out there. I've read and watched a little bit, but there's a volume of work that I haven't touched that I want to be better-versed in. It's important to understand what others have said or are saying about intersex.

So I'm learning, exploring, getting immersed. :)

One thing I keep encountering are metaphors that describe sex as being not black or white since intersex people exist, and thus describing human biological sex as "gray." Or describing sex as a spectrum where male and female are at the ends of the spectrum, and intersex is somewhere in the middle.

I really disagree with these metaphors, because they only make sense if you think that male and female bodies are more real or legitimate than intersex bodies. Colloquially, when we say that something is "gray," we mean that it is confusing. Issues that are complex, where there is a lot of detail to sort through and try to understand, issues that are not clear or straightforward or make a whole lot of sense - that are not black and white - are considered gray.

But intersex is not "gray." The fact that intersex bodies exist is not confusing. The existence of intersex bodies does not contradict the fact that "male" bodies and "female" bodies exist. Additionally, I'd argue that biological sex doesn't exist on a spectrum, where male and female are prioritized as being "real," and intersex people are just some manifestation that's more or less like "real" males or females.

This is sort of like saying that, in a world where only chocolate and vanilla ice cream are commonly found, that the existence of strawberry ice cream threatens the existence of chocolate and vanilla ice cream. Or that strawberry ice cream is somewhere "in between" chocolate and vanilla ice cream. Or that chocolate and vanilla ice cream are the only ice creams that REALLY exist, and that strawberry ice cream is somehow actually chocolate or vanilla ice cream in disguise.

But this doesn't make any sense! Strawberry ice cream exists in its own right. It's not chocolate ice cream. It's not vanialla, either. The existence of strawberry ice cream has nothing to do with chocolate and vanilla ice cream existing. They can all exist, and be treated as legitimate variations of ice cream! Strawberry ice cream also isn't a blend between chocolate and vanilla - the only ice creams that are recognized as real. Strawberry ice cream IS real! In short, its existence doesn't have to be defined in terms of chocolate or vanilla ice cream. It's existence should simply be defined by its strawberriness, period.

This ice cream metaphor, while getting the job done, isn't super-accurate quite yet, either. Intersex isn't just a single category. There's not one way to be intersex. There are many intersex variations out there. So, it's not so much that we should recognize that chocolate and vanilla aren't the only two choices out there, and that strawberry exists. Because it's not just strawberry that exists, but also mint chocolate chip. And rocky road. And cookies n cream. And butterscotch. And raspberry swirl. And many other kinds of ice cream, each of which exist in their own right. Just like our strawberry example, it would be absurd to define butterscoth based on whether it's more like chocolate or more like vanilla ice cream ,or to try and guess whether butterscotch is "really" chocolate or vanilla at its essence. It's butterscotch! Done, and done!

I think that talking about how sex is gray, or that biological sex is a spectrum, is a good first concept to start talking about the fact that sex is more than male or female. But if the metaphors end there, we can only understand intersex as something vaguely between male or female, as something that we can't understand or start talking about without referencing male or females. This erases the fact that intersex exists in its own right, and denies the fact that intersex bodies are real.

What do you think about this?

[Photo courtesy of Natalie Dee]

Coming Clean to Clinicians: An Update

Hey, ya'll. I had recently decided that I'm sick of not being forthcoming with my intersex to health professionals, and am not going to do it anymore, as I detailed in a recent post. My previous experiences were pretty uneventful, with me explaining that I don't get my period to nurses or doctors, or literally writing, "I don't get my period," on the "When was your last cycle?" part of the medical forms. No big deal. It was even kind of easier than I had thought it might be!

So, I was feeling all confident, until I went searching for a new general practitioner (GP). Upon doing so, I've unfortunately had a few uncomfortable experiences.

The first part of my visit was the same. Sit down, fill out the forms. Draw some arrows and cross stuff out where appropriate to state that I don't menstruate. Fill out more forms, wait, wait, wait. Get called in, get your blood pressure taken. Wait, wait. Answer some questions from the nurse, as she fills out some forms. Wait, wait. Finally see the doctor. Answer some questions, suspiciously in the same order that the nurse asked them in. (Doesn't anyone read the forms you initially filled out?!)

At some point in reviewing my medical history, my prospective doctor kind of stopped. "So, it says here that you don't get your period. What is that?" I stopped for a minute, since the question was awkwardly phrased. Um, what did she mean? She must have met people that didn't get their periods before. This happens. "Um, yes, I don't." Pause. "Can you explain why that is?" "Umm, I don't have a uterus." Pause. "I was born without one." I felt that that was more than necessary to satisfy my writing I don't get my period on the form. No uterus = no menstruation. Easy, done!

The doctor had more questions, though. "You were BORN without one?" "Yes." "Why is that?" "Well, um, I'm intersex." Okay, I'd said it. I'd said the word. I waited to see what would happen. "So, uh, you were born, uh...what were you?" "I"m sorry?" "What were you when you were born?" Ohhhhhhhh, the doctor wanted to know if I was REALLY a boy or a girl when I was born. If the doctors had assigned me male or female. My heart sunk. "So, were you ambiguous? Do you have normal female genitalia?" I wish I had been in a mental place to think, "That question's obviously absurd! That's not medically relevant at all! I'm not answering that!" Instead, my mouth blurted out, "No. Yes, I do." And then the rest of the exam I just felt weird and zoned out, and I was terrified that she was going to want to do a check on my genitals to see them for some reason, even though she thankfully didn't.

The reason that I stated that I didn't have a uterus was so that I could explain why I would need prescriptions for hormones that I take daily. I could have never said anything referencing my intersex, could have made up some reason why I took estrogen that would have been entirely plausible, and went on my way.

But I think I deserve to be truthful in my medical history, like everyone else may be. The fact that I'm intersex shouldn't be something I should feel I must hide from my doctor. But it also shouldn't be something that I'm asked about when it's not medically relevant, which just serves to make me uncomfortable, when I've chosen to be honest about this (needlessly) sensitive subject. I very much understand why people just don't say anything about it at all.

It will be okay. I am glad that it wasn't worse, but I recognize that this still isn't acceptable. I want to talk to this doctor again, to let her know that those kind of questions aren't appropriate, that she should not ask inappropriate questions to other patients who happen to be intersex. Me, now? This isn't so terrible. I was upset and angry about it for several days afterward, but I know myself enough and understand enough how intersex is miscontrued in a medical context (= my body is fine, it's not disordered, any messages to the contrary aren't true) that I can bounce back. Me, a decade ago? I would have been deeply upset and felt awful about myself and wondered why I wasn't like everyone else. That I deserved the questions and whatever crappy feelings I had because, after all, who would really ever be aware of what this intersex thing was, anyway? I was not as resilient then, and am only more resilient now because I sought access to accurate information and other views of intersex besides the wow-you're-a-big-freak-BUT-IT'S-OKAY-YOU'RE-NORMAL-as-long-as-you-let-these-doctors-fix-you perspective. If I hadn't found this information, I am not sure what I would think of myself now. I'd probably just pray I'd somehow be convinced I was a "normal" girl after all, but feel awful inside.

And now I know that's not true. But that middle school kid in the doctor's office? Might be much more hurt and upset by a doctor's curiosities. That middle-aged adult that is still hurting so much they can't have conversations about their past? Might have yet another scar to tend to. This isn't fair. No one should be made to feel like this.

I don't know when or how or even if I will talk to this doctor again. It is much easier to talk about intersex in front of a room of people that are there to learn about, explore, and discuss intersex, than it is to directly engage someone who said something stigmatizing about intersex. Even now, it's hard to say, "Hey, that's actually not accurate," or "Actually, intersex people/bodies aren't necessarily like that." It is a process that, like everyone, I'm still working on, and it's not always easy to do, although I'm becoming much braver at it with regards to intersex. All I know is that as more experiences occur such as this one, the more I am reminded how important it is to have conversations about intersex, to acknowledge it exists.

I want to go to a doctor's office someday and know that I can disclose all the parts of my medical history and not feel strange about it, not feel like I need to choose between honesty and hiding. It is ironic to me that since intersex has been misconstrued as a medical issue, that more doctors are not aware that intersex exists, and they are not adequately trained or prepared to talk with intersex individuals who come into their practices, looking for basic medical care like anyone else. Maybe it won't happen soon, but I hope to fill out my medical history someday without wondering if I'll get asked shitty questions, if I'm going to have a uncommonly bad rest of the day simply because I had the absolutely common experience of going to the doctor. When that day comes, it's going to be a good day.