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An Open Letter to The ISNA Regarding How Discussing Intersex Is Vital to Our Understanding Of Gender Identity and Vice Versa

S. Yaeger's picture

Shannon Yaeger



Dear Intersex Society of North America,

I recently stumbled across your website, and your table titled “Shifting The Paradigm of Intersex Treatment.”  I found the site while doing research for a course in gender and sex and was fairly surprised at the following answer to the question of nature vs. nurture’s role in gender:

“Both, surely, but that isn't the point. The point is that people with intersex conditions ought to be treated with the same basic ethical principles as everyone else—respect for their autonomy and self-determination, truth about their bodies and their lives, and freedom from discrimination. Physicians, researchers, and gender theorists should stop using people with intersex conditions in “nature/nurture” experiments or debates.”

I found the preceding quote very striking, not because it answers the question of Nature vs. Nurture so quickly and dismissively, but because it is demanding that those who study gender, and who advocate for more open societal view of gender, to completely exclude intersex conditions which may be vital to furthering our understanding of gender as topics of our discussions on how gender is determined.  While I do understand that having one’s condition used as fodder for debate can sometimes be a frustrating experience, especially if the person in question is neither include nor interested in said debate, I feel as though your demand for exclusion could very well be barring gender theorists from furthering a vital understanding of gender as a construction of many different aspects. 

I recently heard an anecdote in which a gender theorist and activist introduced herself to an intersex theorist and was sharply rebuked.  She was essentially told that intersex is disorder of the endocrine system and, thus, had no place in gender studies.  While, again, I can understand why making the distinction between a clearly defined biological disorder and a difficult to understand and define concept is important to the task of self-identity for those with intersex conditions, I am not sure if I agree that the divide between such conditions and gender itself one that ought to be held so tightly.  Additionally, as more babies with intersex conditions are not surgically altered at birth and instead are allowed to decide their own sex later in life, the field of gender studies may be as vital to intersex studies as intersex studies are helpful to the study of gender in general. Though I think that both disciplines would agree that when the question of nature vs. nurture arises it is impossible to isolate a clear determinate of gender, the very fact that intersex conditions are biological in nature can help us to understand and explain the complex relationship between sex and gender.  This furthering of understanding is impossible without an understanding of how biological processes inform or don’t inform our physical sex. 

I have recently seen several studies of the way hormones, specifically testosterone, can influence behavior.  While these studies are useful in understanding exactly how complex the relationship between hormones and behavior can be and how hormones can inform gender typical actions, they are not exactly useful in understanding the relationship between sex and gender identity. For example, one study suggests that higher levels of testosterone in female subjects can decrease how trustworthy the subjects perceive other to be.  The correlation between testosterone and trust in this study shows how the male hormone can potentially affect a behavior which is widely accepted as feminine (trusting), but it does little to further our understanding of how hormone levels can affect the way one identifies as one gender or the other, or the way that gender identity and sexual attraction interact.  It is my understanding that many studies have been done which examine the role of biological processes in gender, but that none of them have been wholly helpful in furthering our understanding. This is where the study of intersex disorders comes in.

Understanding how those born with intersex conditions interact with both their assigned gender identities and their assigned or unassigned sex can help us to understand how those who are born with typical genitalia interact with theirs.  For example, understanding how an individual with Androgen Insensitivity Disorder can be born chromosomally male but with female genitalia, and how that individual’s hormones are received by their brain may actually help us to understand how an individual who is born with male chromosomes and a typically male hormone reception structure can eventually come to know themselves as female.  Similarly, understanding how those born with atypical genitalia and who are assigned a sex at birth can grow up to understand their sex assignment as being the right one for them can help us to understand the somewhat random nature of gender identity.  Finally, and perhaps most importantly, understanding how a child who is born with atypical genitalia and not assigned a sex at birth but is assigned goes on to eventually choose a sex which is traditionally aligned with their gender, or one which isn’t, can help us to both understand and explain the possible lack of relationship between biological sex and consciousness driven gender in a way that the study of those with typical hormone structures and genitalia cannot.

I know that it may seem strange to predicate an argument about the usefulness of understanding and discussing something which has a fairly clear biological origin on the fact that a clear biological origin is unimportant, but it is exactly the fact that intersex conditions are caused by differing biological functions which drives their usefulness in understand that which is not.   Often when studying the relationship between sex and gender, theorists are left somewhat empty handed in that all of the examples in which there is strict relationship are those which reinforce the societal view that sex does and ought determine gender.  By understanding situations were a clear relationship between the two cannot be determined because one is not present in a typical way, we can find a concrete lack of relationship to which we can point as evidence that role of sex in gender is unclear, and may always remain so.  Additionally, this potential discussion point allows us to further push for a wider societal understanding of transgendered individuals as not flawed or somehow disordered, but as atypical.  Conversely, a wider societal openness toward those whose genders are not so closely aligned with their sex has the potential to create greater opportunity for those who are born with atypical genitalia or atypical endocrine systems to be more free in their pursuit of acceptance and understanding. 

Thus, I find it somewhat baffling to me that your organization would advocate for exclusion from debate regarding gender when the potential for increased freedom and understanding across disciplines is so great when the issue of intersex is included.  Additionally, by demanding exclusion, it seems to me that you are necessarily also barring the insights and ideas of organizations like yours from being including in a wider push for shifting paradigms.  This self-exclusion has the potential to limit the ability of those who have intersex disorders to gain a voice in a debate which may lead to their ability to live more freely and more happily.


Works Cited

Intersex Society of North America Website. Shifting the Paradigm of Intersex Treatment. Published 2007. Accessed 2011.

Peter A. Bos, David Terburg, and Jack van Honk. “Testosterone Decreases Trust in Socially Naïve Humans.”  Proceedings of the National Academy of Sciences 107, 22 (2010):  9991-9995





Kaye's picture

diffracting ISNA's claim and IRB guidelines

Thank you for this open letter that directly addresses ISNA's argument that "(p)hysicians, researchers, and gender theorists should stop using people with intersex conditions in 'nature/nurture' experiments and debates." While ISNA claims that such experiments and debates are unfair to those living with intersex conditions and are unethical, you mount the counterclaim that gender theorists and the people whom ISNA serves could both benefit by collaborating.  In your letter, you highlight how the current understanding of relationships between sex assignment and gender identity is limited and that by examining instances in which the biology does not lead to clear sex assignment, we may deepen our understanding of the roles that hormones and anatomy do and do not play in gender identity. 

Although you don’t address the ISNA’s objection to biomedical and psychological research, I was struck by the resonance between your argument (for including theoretical work on intersex and gender identity) and the guidelines for federally funded research with human subjects, which would include clinical research on intersex conditions in humans.  Human subject research requires approval by an IRB (Institutional Review Board) committee with special training in the legal and ethical ramifications of such studies.  The committee reviews proposals to determine whether the research design minimizes risks to human subjects and that any risks are reasonable in relation to possible benefits for the subjects themselves and the knowledge that may result.  You address this concern by arguing that people with intersex conditions as well as others in the society (e.g., those who are transgender) have the potential to benefit from the work of gender theorists on intersexuality.  In addition, transgender issues are particularly important to the intersex community.  The ISNA notes on their “Shifting the Paradigm” sheet that “doctors and parents recognize, however, that gender assignment of infants with intersex conditions as male or female, as with assignment of any infant, is preliminary. Any child may decide later in life to change their gender assignment; but children with intersex conditions have significantly higher rates of gender transition than the general population, with or without treatment.” 

IRB committees also assess whether subjects are adequately informed of the risks, whether they can freely choose to participate or not (and even change their minds), and whether the privacy of the subjects will be protected.  I would argue that there is no additional risk to those with intersex conditions if these conditions are discussed in gender studies classrooms or in publications and presentations by gender theorists.  While Anne and I did not ask people with intersex conditions whether or not we should discuss these issues in our class, you point out that restricting such discussions in gender studies courses would prevent “the insights and ideas of organizations like yours from being including in a wider push for shifting paradigms.”  Given that the only “named” cases in our texts and discussions are those who have publicly identified themselves as having an intersex condition, the issue of ensuring their privacy is moot. 

I found your concluding sentence to be quite powerful:  “This self-exclusion has the potential to limit the ability of those who have intersex disorders to gain a voice in a debate which may lead to their ability to live more freely and more happily.”  I’d like to turn this into a call for action and invite those specific voices into our debates.  Perhaps, some will respond to your web event. 

I do hope you will send this to the ISNA, but would suggest that you make some edits to your letter before doing so.  I’d be happy to meet with you and discuss these in more detail.