Story

Will, a photographer, wanted to see what all the commotion was about with the people gathering.  He dressed conservative so as to blend in with the crowd.  As he got closer he heard what was going on.  People that were used to "their type of people" found out that there was to be "Other Types" in their area.  Then the name-calling started:  Fag!  Freak! but it did not stop with name calling and those others, at least on that day, did not gain entrance. 

Did those in the crowd know these people, No. 

Had those turned away departed because they were fags, freaks or was it just the perception that they were. 

Fact of the matter is those turned away had nothing to be shameful of at all and when they did depart, they did so with heads held high in dignity.  Will captured some of these moments on film.

This happened in the recent past . . . well,  recent if you're a redwood tree.

While the story above is true, some of the facts have been changed to stimulate your thoughts.

Some of you may have recognized the facts in this story.  The "Will" in the story was Will Counts, who in 1957, when 15 year old Elizabeath Eckford, one of nine African American students attempted to enroll in an all white school mandated by the landmark 1945 Brown v. (Topeka) Board of Education Supreme Court Decision was indeed the photographer capturing the moment in time.1

It wasn't until 1866 that the African American people in America could marry at all.  And it wasn't until 101 years later that a African American person could marry a white person in all 50 states.  Early in the nation's history, a married white woman had no rights.  Between the 1830's and 1870's, states began passing property laws that allowed women keep items/property that they brought to the marriage if they divorced.2  

How far we have come in dealing with oppression and discrimination, . . . . . . or have we?

My focus today is intersexuality.  This cannot be expressed completely without a basic understanding of gender diversity.  I hope that you had the opportunity to attend the Gender and the Law Symposium held here on 27 February. 

About Me

Before I begin, I should say a bit about myself.  I am not a lawyer, nor am I a physician.  I don't come to you today with all the answers, I don't even know all the questions and if you leave here today with more questions than then answers on gender than I have done my job. 

I feel I am qualified to discuss gender issues in depth because of the real life experience I bring to you with my own gender blessing.  The depth comes from my own curiosity and research abilities, honed as a researcher analyst, first for the military and today, as a contractor for the military and as an adjunct lecturer for three colleges.

I began life being subjectively categorized as a male.  As soon as I heard this "It's a Boy" I tried to object, LOUDLY even, but they did not listen. 

From the age of about 10 I understood that I was not the same as most children and suffered many altercations and abuse because of this fact. 

I will add here that I did have a wonderful family life and wanted for little.

I learned at an early age that it easier to emulate that which was expected and get along, rather than make waves.  While this may have done me a service, it surely did nothing to resolve the underlying issues, which at this point I did not understand.

Late in high school I found relief by becoming immersed in school, then work but found it was only temporary relief.

I married because I found someone who makes me feel whole and who I am empty without.  I was also looking for some normalcy in my life.  However it surely turned out to be anything but normal.  I will say that, today, my spouse is still with me having assisted me in every step and with every choice I, no we maded.

We have a daughter. . . . That one normally gets people to thinking "But. . . But you're. . . " Yes, that's right, and I normally respond with, medical science and doctors today can do wonderful things.  

All anyone need know is that she is my / our daughter.

I stated earlier I was in the military.  Actually, I am retired after having served for over 21 years.  When I left active duty, I was gone for almost two weeks and then, was back at my desk as an employee of a large support contractor who has over 68,000 individuals employed and, I will add, has a great nondiscrimination policy.  Their legal and human resource office has supported me from day one.

I will say that dealing with the military has for the most part been easy.  That may surprise some of you but, in fact, in 1999 the military changed their EO policy and it includes gender.  "The Army will provide equal opportunity and fair treatment for military personnel, family members and Department of the Army civilians without regard to race, color, gender, religious or national origin and provide an environment free of unlawful discrimination and offensive behavior."3   That said I will not stand here and state all went well.  There were a few individuals that attempted to enforce their perspectives on everyone else and one in a leadership position saw fit to distort facts or withhold information that would have made things easier for all, me included.

Here I should interject that I was born in Florida.  For those that were here for the recent Gender and the Law Symposium you may recall that I asked Shannon about the second or third level impacts of a decision in the Kantras case pending in Florida.  Measures to have my birth record corrected have been ongoing for years.  Introducing legislation has been a slow process and when the political winds change, so do minds of some helping the movement.  Florida is one of only four states (Idaho, Ohio, Tennesse and who knows what is going on in Texas) that currently does not allow for correction.  If I could obtain a corrected copy of my birth certificate, many issues that surfaced would have floundered quickly.  As it is documents such as my passport, driver's license and even a court order have not provided adequate proof to some people.  At one time, I was even accused of forging these documents.

Today, I stand before you having chosen to have corrective surgery because it was right for ME.  I have had two surgical procedures.  However, there are some that have had over a dozen; many beginning prior to their consent or, in my opinion, understanding.  For me surgery provides congruency between my gender and body.  I am not saying that surgery is right for everyone that may be in a similar situation and is certainly not right for a child that has yet to understand gender and the possible ramifications of surgery.  For some the correct hormones may be enough.  Because I have chosen to adopt societies bi-polar gender system, living on the end of the spectrum right for me, does not mean its right for everyone.

It would not be right if I did not speak of the spiritual impact this has had on me and many others.  I had a hard time trying to understand a Creator who allowed this to happen and had even been asked by the family how the Creator could expect anyone to live in the middle.  I did, however, come to find peace in my spiritual self, knowing that the Creator has a purpose in everything.  I will not get into a theological discussion, but will say that it is by the Creator's grace and my faith that I know where my life is going.  For the here and now, that is surely in the right direction.

For more insight on me try my web site4

Intersexuality

Today I am here to speak on intersexuality. 

Let me first pause and reflect on what it is that

makes up an individuals gender.  Please consider

that gender is a complex construct consisting not

only of the "Chromosomes at birth, . . . which are

only one factor in determining an individual's sex

later in life. Seven additional criteria matter too:

gonadal sex (testes or ovaries), internal morphologic

sex (prostate or uterus), external morphologic sex

(genitalia), hormonal sex (androgens or estrogens),

phenotypic sex (secondary sexual features like chest

hair), assigned sex and gender of rearing, and sexual

identity"5.        

Generic definitions for Hermaphrodites, or the Intersexed, are individuals who have both ovarian and testicular tissue in their bodies; their external genitalia can be a mixture of both female and male structures.  This can manifest itself in many ways.  Having both complete sets of genitalia is very rare being fewer than five percent of those that are intersexual.6  

Pseudohermaphrodites are individuals whose structures may match their chromosomal sex, but whose internal and external reproductive anatomy has a mixture of female and male structures or structures that are incomplete.

While these are the textbook definitions, I will add the following as to some causes of these abnormalities:7

Androgen Insensitivity Syndrome (AIS)

Gonadal Dysgenesis

5 -Reductase Deficiency

Testosterone Biosynthetic Defects

Micropenis

Timing Defect

Congenital Adrenal Hyperplasia (CAH)

Klinefelter Syndrome 47XXY

Turner Syndrome

46,XO/46,XY Mosaicism

Combine these with what we have already discussed are the attributes that make up an individuals gender and you begin to see the complexity of gender makeup.

Thanks to the study of intersexuality, we have, long ago, realized that humanity comes in more than two mutually exclusive genders.

The instance of gender abnormalities has

been estimated to be between one in every

5008  to 45009  (1 in 2000 mostly).  If accurate,

this means that more babies are born

intersexed than those born with cystic fibrosis,

the incidence of which is one in 2,500.10

Consider that even the intersexuals themselves often do not know the extent of their abnormalities because of misinformation or lack thereof.  The following is from an individual, Jim, born in 1957.  His parents started to tentatively raise him as a girl, but he identified as a boy, looked like a boy, so they raised him as he identified. 

No medical workup was done until puberty, at the age of 14, when he was the interest of study at a gender clinic but not treated well. 

"They tried to force genital surgery (mutilation) on me with the claim that I could not

function in life as I was.  Giving up on the gender clinic, a local endocrinologist

determined that there was no testicular material and begun testosterone

treatment."

Traumatized by the ordeal of the gender clinic, Jim did not seek any serious medical evaluation for intersexuality until October 2001 when a complete workup was done.  Here, Jim reveals the outcome of some of these tests:

"I've got tiny, underdeveloped ovaries that produce estrogen only.  I don't cycle in

any way, don't ovulate, never menstruated and didn't even know I had a vagina

because the opening used to be so tiny (used to be - I had that fixed!).  I take

complete testosterone replacement and you'd never know I had a "normal for

female" estrogen level, with a "normal for male" progesterone level.  My secondary

sex characteristics are purely male.  My specialist ordered a complete hormone

profile on me last October, among a whole lot of other tests that finally uncovered

my physical makeup.  This had never been done before.  In any event, my point is

that it all gets pretty complex!  Jim"

After getting help from competent caregivers Jim states:

"I don't look at myself as having an abnormality.  I've gone from a miserable

self-image of believing I was a man, a malformed male, to discovering that I am a

man who is a perfectly formed intersexual variation of a female."

Before we move on to the legal area of intersexualism, Jim had a question:

"All my documentation says "male" and has a male name.  I have never

transitioned from one gender to another, so I don't have the kinds of things a

transsexual would have in order to meet the requirements necessary to change the

gender on a birth certificate.  BUT, I have a birth certificate that says female on it. 

This makes it impossible for me to get a passport!"

I contend that Jim, an intersexual, is no different than a female to male transsexual that does not have complete bottom surgery (phalloplasty), which is often extremely costly and the results less than satisfactory.

 

Legally Speaking

Family Court of Australia11

In Sydney, the judgment of the Honorable Justice Chrisholm

His Honour made a number of important findings of fact and of principle such as:

"There may be circumstances in which a person who at birth had gonads,

chromosomes and genitals of one sex, may nevertheless be of the other sex at the

date of his or her marriage . . . "

"The decision of Corbett does

not represent Australian law"  "That

brain development is (at least) an

important determinant of a person's

sense of being a man or a woman,

that the characteristics of transsexuals

are as much "biological" as those of

people thought of as inter-sex . . ." 

"Thus, transsexualism is found to

be properly included within the intersex

continuum."

Some do not see the finding of justice Chrisholm as those above and wish to maintain distance between the intersexual and transsexual individuals.12

From this, I have corresponded with Dr. Milton Diamond and asked the question, where does one draw the line or can one draw a line between intersexualism and transsexualism?  He comment was that this question alone is to complex for a quick answer and has two books to be released latter this year.13

The Kantaras case in Florida

"As part of his ruling, Judge O'Brien must decide whether Kantaras, 42, who had

his breasts, ovaries and uterus removed and takes male hormones, is legally a

male.  He never took his medical treatments as far as phalloplasty  the construction

of a penis using fat and skin." 14

I ask you, is this really different from an intersexual

that has to deal with these issues from the beginning

of their lives?  Given the construct of gender that we

covered prior, I feel you should at least know what my

answer is.  What difference does it make what gender

the individual is as long as they are a loving parent as

the case is mainly deciding on the rights of a parent to

see their children?  I know that this case goes deeper

in defining the marriage and the adoption validity.  If

this individual is found to be male, as he obviously is,

then does this not establish precedence for Florida and the other remaining states to allow the correction of birth records? 

Consider the following intersexual who's birth certificate says:  "indeterminate" under gender.  His boss became aware of his being intersexed and started to sexually harass him shamelessly and in front of lots of witnesses over a long period of time.  When he tried to take legal action against the harassment he was told that he couldn't make a claim of sexual harassment because he didn't have a sex!  He was told that he didn't fall inside the legal definitions or male/female so the harassment laws didn't cover him.  In the end he accepted a settlement and transfer and the case was dropped.

Yale Law and Policy Review examines surgical liability regarding Intersex condition.

Ford's groundbreaking article examines liability issues related to performing medically unnecessary surgery with no proven benefit to the patient, and concludes:

"Surgeons who perform genetic normalizing surgery [...] should be aware that,

because genital-normalizing surgery is not necessary, nor proven beneficial for the

infant with clitoromegaly or micropenis, the required elements of legal informed

consent are likely to have not been met.  In light of the questionable scientific basis

behind its use, the lack of follow-up data on its benefits, and the overwhelming

evidence of its negative physical and psychological results for many intersexuals, a

moratorium should be declared on the use of defenseless infants as the

experimental subjects of genital-normalizing surgery." 15

This is purely Infant Genital Mutilation (IGM)

Surgery of Mutilation

FGM is done for no legitimate medical reason, is forced on young children, often causes life-long distress, suffering, and medical complications, can cause infertility, and can have a devastating affect on whole extended families.  In these ways it is exactly the same as IGM.

In very few cases of IGM is there any suggestion of a medical condition that needs surgery. As the mutilation carried out by surgeons is done ENTIRELY for cultural reasons, it is difficult to see how this can be considered any different from FGM.

While we have made strides in changing the guidelines in pediatric care there are still documents that have children being subjected to unnecessary surgery.  Consider this document from the American Academy of Pediatrics, July 2000 issue

" . . . usually performed between six and 18 months of age, usually in one stage as

an outpatient procedure."16

Others like NOCIRC17  state,

"Intersexuality is not a life-threatening illness, except perhaps in rare cases, so

immediate surgery usually is not required.  It is the intersex child, and not the

parents, who is the patient.  It is the intersex child, and not the parents, who must

dwell within her/his body.  It is the intersex child, and not the parents, who legally

must decide about body-altering irreversible surgery when s/he is of age." 

This perspective is shared by many others including myself. 18

You don't have to take my word for this.  Listen to the children - they are the ones who will have to live with the decision.

"I would like to see the age limits completely scrapped, and maturity brought in.  As

you grow up, your age has a stereotype.  I'm trying to escape from that stereotype."

-- Robin, aged 13 - quoted in Children's Consent to Surgery19 

There are two major, unwarranted and unsubstantiated claims by doctors involved in IGM.

1)they believe they can decide which gender to assign someone, and

2)that there are only two choices - male and female

The nature of diagnosising the intersexed individuals gender is time-consuming and based on the gender theory that gender be assigned at birth.  This alone presents the physician as well as parents with a dilemma if they strive to place the child in one of the customary genders, male or female.

The belief that gender consist of two exclusive types is maintained and perpetuated by the medical community in the face of incontrovertible physical evidence that this is not mandated by biology.20    

Conclusion

Gender blessed individuals are at the mercy of the medical and legal establishments, often at enormous expense monetarily, emotionally and physically for which we have little or no coverage, guarantee or control.  The fact that our identities, destinies, our very bodies can be dictated to us by others I hope is appalling to you as it is me.

It is my sincere hope that out of this you take a new perspective on an often invisible part of humanity.  Invisible because it has been easier for many to blend into society rather than make waves.  Invisible because many of us will not be exploited on daytime TV but have families and fulfilling jobs, basically a life.  We are behaved individuals that are seen just as that.  The only time things arise are when things go wrong. 

I look at the Kantaras case in Florida and the Littleton case in Texas as opportunism! reinforcing a bi-polar society.  Because the Intersexed often are those in-between we do slide through the cracks.  With your knowledge I pray that you leave here better equipped to provide the advancement and diffusion of knowledge and understanding we so desperately need.

Lastly, I leave you with the conclusion Cheryl Chase, from ISNA,21 said about gender care after her research. 

"Every generation of intersex specialist has characterized the work of the previous

generation as terrible . . . I have no doubt that, twenty years from now, the next

generation of medical intersex specialist will be shaking their heads over the

'terrible' price that was extracted on intersexed. . ."22  

I think the same can be said about our legal system and the legal issues those with these gender blessings face.  The difference here is that You are the next generation.  Armed with this knowledge, it is now in your hands.

__________________________________________________________________

1  Crisis at Central High by Helen E. Starweather, Smithsonian Magazine 

2  See Kansas case adds to debate on transsexual rights, same-sex marriages By Stacy Downs Kansas City Star March 3, 2002 at: http://www.kcstar.com/

3  Respecting Soldiers by MSG Bob Haskell, February 2001 Soldiers Magazine

4  See DaleLynn's web site at:  www.kindredspiritlakeside.homestead.com

5  See Whom can transsexuals marry? And from whom can they inherit? By Joanna Grossman lawjlg@hofstra.edu  NOTE: This was published after the second Gardiner case

See From http://slate.msn.com/?id=2063410, The Trying Game The mutual frustration of transsexuals and conservatives.  By William Saletan

6  See Lessons from the Intersexed, Suzanne J. Kessler p. 14

and: Mariano Castro-Magana, Moris Angulo, and Platon J. Collipp, "Management of the Child with Ambiguous Genitalia", Medical Aspects of Human Sexuality 18, no. 4  (April 1984): 172-188

7  See Division of Pediatric Endocrinology in the Department of Pediatrics at the Johns Hopkins University in Baltimore, Maryland at:  http://www.hopkinsmedicine.org/pediatricendocrinology/intersex/sd4.html

8  See Ethel Sloane, Biology of Women, 3d ed. (Albany: Delmar Publishers, 1993), p. 168

9  See National Organization of Circumcision Information Resource Centers at:  http://www.nocirc.org/intersexed/ and

See Surgical Treatment of Infants with Ambiguous Genitalia: Deficiencies in the Standard of Care and Informed Consent by Hazel Glenn Beh and Milton Diamond http://www.afn.org/~sfcommed/B&D.htm and

See Dove on Heterosexism John Hopkins University Archives at: http://www.cs.jhu.edu/~jonathan/debate/ceda-l/archive/CEDA-L-Apr-1997/msg01080.html

http://www.intersexsupport.org/intersex_defined.htm

10  See The Gender Puzzle/2 October 28 2001, Sunday Times Magazine at:

http://www.sunday-times.co.uk/news/pages/Sunday-Times/stimazmaz01014.html

11  See Kevin and Jennifer v The Attorney General for the Commonwealth SY8136/99 at: http://www.wallbanks.com/news.html and http://www.familycourt.gov.au/judge/2001/html/rekevin_text.html

12   See Androgen Insensitivity Syndrome Support Group (Australia), Intersex Information Booklet at: http://home.vicnet.net.au/~aissg/

13  "In the Phallus Palace" edited by Dean Kotula and a  journal "Clinical Child Psychology & Psychiatry"   Dr. DIamond's web site at www.hawaii.edu/PCSS

14  See Mat Bean, Lawyers have last word at: http://www.courttv.com/trials/kantaras/020802_ctv.html

15  Ford, Kishka-Kamari. 2001. "First, Do No Harm" - The Fiction of Legal Parental Consent to Genital-Normalizing Surgery on Intersexed Infants. Yale Law and Policy Review 19 (469).

16  See Evaluation of the Newborn With Developmental Anomalies of the External Genitalia (RE9958) American academy of pediatrics at:  http://www.aap.org/policy/re9958.html

17  See National Organization of Circumcision Information Resource Centers at: http://www.nocirc.org/intersexed/

18  See Sarah Creighton,  Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospitals, London WC1E 6DH

See Catherine Minto, Academic Unit of Obstetrics and Gynecology, University College London, London WC1E 6AU

19  See Alderson P. Children's consent to surgery. Buckingham: Open University Press, 1993:9.

20  See Lessons from the Intersexed, Suzanne J. Kessler p. 31

21  ISNA Intersexed Society of North America:  http://www.isna.org

22  See Cheryl Chase "'Corrective' Surgery Unnecessary:  Reply to Is It a Boy or a Girl?" John Hopkins Magazine 46, no 1 (Feb 1994)

A Special Thanks to ISNA, NTAC and IFGE for allowing dissemnation of their literature.

Organisation Intersex International

Perspectives on Intersexuality

by Dalelynn

Outline from presentation at the Georgetown Universiy Law Center