Talk:Intersex/Archive 3

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Sports events???

"Typical males have sex chromosomes XY and typical females XX. One biological definition of a male child is the presence of a Y chromosome. This definition has sometimes been used for sex determination at sports events, but it caused much confusion because it does not always apply."

Not sure what chromosomes have to do with sports events and why anyone would engage in "sex determination" at a baseball or football game??? That just sounds weird. JadedKat 18:38, 4 September 2006 (UTC)

Sex determination has been a major issue in the Olympics and other sports. The International Olympic Committee recently banned the practice. Jokestress 18:12, 10 September 2006 (UTC)

It's precisely because there are male and female events that sex determination is needed. The same is also true for all other types of sex differentiation - like marriage (who is an intersex person allowed to marry; what tests will apply), birth certificates etc. —The preceding unsigned comment was added by Matthew238 (talk • contribs) .

However, there have been instances in which XY women (that is, people who possessed XY chromosomes but due to androgen insensitivity syndrome developed as female) have been challenged by the IOC (Maria Patiño is a well-known case, but there have been others). What's at issue here is not whether sex-determination is "needed" (that's not a debate I'm going to get into because I'm not interested in it). Granting for the sake of the discussion, though, that it is needed, the question is whether the discovery of a Y chromosome in and of itself should carry such weight that it negates all other factors, especially female anatomical development (which is the central consideration; it's male size and muscle mass that alters athletic performance, not the Y chromosome). The IOC has decided that it does not, and has rejected reliance on karyotyping for precisely this reason. --7Kim 10:29, 23 December 2006 (UTC)

Image issue

I moved the image of genitalia from the top of the article, and I question its need altogether. It certainly doesn't need to be at the top of the article, which clearly states that not all intersex variance involve genital anomalies. Further, having it as the only image reinforces the stereotype that intersex IS about genitalia only. I'd vote to remove it. Thoughts? Jokestress 18:12, 10 September 2006 (UTC)

I would tend to agree, though I may be a tad late to do so. 24.169.115.41 04:00, 6 February 2007 (UTC)

I'm just deleting that image. Miagirljmw14 Miagirljmw_talk 17:31, 26 August 2008 (UTC)

new NYTimes article

The editors here may find this article of interest, as i do not yet see a reference to it in the article or on talk. Derex 22:42, 24 September 2006 (UTC)

Comment - in reading the article above and researching the Wikipedia article, I certainly agree that any modification to an intersexual person should be the informed decision of that adult person alone. That said, nowhere is the presence or absence of male or female fertility considered as a factor. An intersex person potentially capable of fathering a child should not be deprived of that possibility by medical intervention. Similarly, an intersexual that produces ova and has a uterus should not be deprived of the possibility of becoming a mother. SEIBasaurus Don

Intersexuality and Transsexuality

Not all intersexuality is necessarily discovered at birth - some people have undiagnoised intersexuality that only comes to light when infertility and other medical tests come to mind - It is possible to be both intersexual ( infertile, high levels of female hormones ) and to be transexual - though both conditions are rare and I agree normal transexual people can father children whereas intersex people usually can't I have an unspecified diagnoisis of intersexuality / transexuality - I could not have children due to high lh levels prior to hormonal treatment in my body. other examples included no adams apple and a high pitched voice within the female vocal range - something I had had for life

I dont really see myself as intersexual or transexual though I can understand why people deem transexual as not intersexual - to me the treatment of both intersexuals and transexuals is just as bad - by society in general - The word freak springs to mind as does the word discrimination and the high incidence of depression and reluctance to let others get close to you for fear of judging you as a person.

discrimination is severe in medical, employment and other fields of life where you are made to feel as a second class citizen. I agree that some intersexed people never know in life they were intersexed though I find that hard to believe if ever u want children - I knew I wasn't an ordinary male from as a child my bullying was relentless - now the options are far more advanced for picking up problems like this.

This article is accurate but it needs to educate people more - there is much myth and mysterious surrounding the taboo of intersexuality and transexuality (the previous comment is unsigned from User:Intersex).

The issue between intersex and transsexual is one of medical rights, and legal recognition. By definition of the criteria in the DSMV IV for Gender Identity Disorder, one cannot qualify for it if one is intersex. Also, as such, most states recognize intersexed individuals as being non-transsexual and insurance may actually cover costs in order to reassign sex. (Being as the assertion can be that because of the ambiguity at birth, the legal gender of the person was wrongly determined.) Yes, there are intersex cases that can effect fertility, AIS can cause only infertility in a man, or it may even go as light as not having any noticable effect on fertility or anything other. Now, excepting that, CAIS can often be entirely undiagnosed until the person goes to a fertility clinic to find out why she cannot get pregnant. (Surprise, it's because you have testicles!) In any case, intersexed individuals generally have special recognized rights by medical organisations, because there is an explicit medical condition that they can point to and say that is what is wrong with them, unlike transsexuality, which I suppose could be marked as "psychological intersexuality", but as such, it's unclear at this time that legally it should be treated with gender reassignment. As such, if a woman with CAIS finds out that this is her problem, her testicles will be removed, and no insurance company would claim that this is not appropriate, called for, and legitimate surgery. Meanwhile, a transsexual with no other indications of intersexuality requires a full year of living as a female before they are allowed to have their testicles removed. --Puellanivis 00:47, 15 November 2006 (UTC)

As Puellanivis points out, there are several reasons why intersex and transsexual conditions are regarded as separate. the DSM-IV explicitly states that to have GID you don't have a concurrent intersex condition.

This is, however, misleading. As in Etiology of transsexualism there is quite a bit of professional belief that there is an underlying physical abnormality leading to transsexualism. There are currently gene surveys and other studies seeking to answer this question.

Essentially, many professionals believe that transsexualism will one day be shown to be an intersex condition where the brain is not responsive to normal sexual differentiation. There are apparently many in the intersex community who avidly fight such assertions; this may be because there may be an impingement on their rights if they are recognized as the same.

Lwollert 01:14, 7 February 2007 (UTC)

I believe in Iran, transsexuality is already seen as a form of intersexuality, which thus justifies the sex therapy treatment that transsexuals can receive. Although, along with this position comes their hardlined stance that once approved for surgery, you must undergo surgery. Their position being that if you're truly an "intersexed" transsexual, then your genitalia should be corrected to match your true sex, still basically applying a binary female-male opposites view on gender.

I think the problems that those in the intersexed community would be concerned about most would be that intersexuality would conflate in people's mind to transsexuality. Much like transsexuality has ended up "merging" with homosexuality mentally for most people, with them simply assuming that transsexuals are just "really really gay". Leading to people perfectly accepting of transsexuality becoming confused when actually presented with what transsexuality is. "What? You mean there are lesbian transsexuals?" is one response I heard from a relative, and of course the favorite response that I hear most commonly from people when talking about a MTF transsexual, the inquiry that it seems like something drastic, and that maybe they might just be a gay man. I think that typically my question in response to that should be, "did you ever stop to think she might be a lesbian?" It kind of gets the point across that just because you're transsexual doesn't mean that you're into the people of your assigned gender.

So, I certainly understand a reluctance of intersexed individuals looking to keep a clear distinction between them and transsexuals (which I think is reasonable.) As they are typically treated in different ways, and have clearly different indications, just like homosexual and transsexual. So, while I wouldn't mind people recognizing transsexuality as a form of intersexed, it's reasonable that it should remain clear that transsexuality is an intersexed condition with no physical indications, and thus seperate in treatment, therapy, and diagnosis from any other intersexed condition. --Puellanivis 07:44, 7 February 2007 (UTC)

"hermaphrodite introduced in the 19th century"

what does it talking about. that's an ancient greek term from the gods hermes and aphrodite. just because a source talks nonsense it doesn't mean it should be in here. --87.194.72.129 22:14, 26 December 2006 (UTC)

Hermaphrodite was indeed in reference to a combination of those two Greek gods; however the term was used descriptively within medicine from about the 19th century Lwollert 01:15, 7 February 2007 (UTC)

Broken Link

I took away this link because leading to a commercia/fake dite. If anyone can find the link to the real document (if it exists) please, feel free to insert the new link in the article page.

• Human Rights Investigation into the medical "normalization" of intersex people - a report of a hearing of the San Francisco Human Rights Commission - PDF format —The preceding unsigned comment was added by 84.190.32.46 (talk) 20:27, 15 January 2007 (UTC).
  • I corrected the link and reinstated on the article page.

Velps's Changes

Since I've reverted one change, then revert all three changes that encompass the contributions of Velps, I felt it appropriate to talk about the reasoning.

Even in cultures where surgery is not possible, intersexed people are expected to pick a sex, even though surgery is entirely unavailable, and conform to the gender roles of that sex. Surgery is not a be all end all "correction" for Intersexuality, although in the modern day it may be viewed as such.

One contribution of Velps changed "to resemble either male or female genitals" to "to resemble more typically looking male or female genitals". I feel that this is redundant information. "To resemble" already means "to look-like", or "to approximate", and the specific wording presents the position that intersexed people are non-typical. (While they may be a minority, 'typical' has an indefinite meaning.) Which presents a feeling (at least in me) of a POV statement that a "correction" is necessary to make them look normal (synonym to "typical".)

I'm with you on being very careful about what is said in this article. Sex is so personal, and yet so social, even boring old average generics get fussed over whether they are "normal" or not. The thing is, I think Velps, was possibly trying to make exactly the point you and I would make, maybe he (she, neither, both or something special) just didn't phrase it ideally. Actually, I think the point in those words is that even male and female genitals have variation, just like eye colour and height, so surgery can't really make anything female, for example, because there is only a broad "typical", not an exact definition. I agree with you in the end, there's just too many words and they are redundant; however, if we all stay cool, perhaps we won't feel the need to produce cumbersome sentences to avoid causing offence. Let's just keep refining things, that's the whole fun of Wiki, it doesn't have to be right first time, what matters is where it ends up. This article has tons of good sourced material, but it's always going to be touchy in some wording. Thanks for your direct, clear and simple suggestion, I'm with you anyway. Alastair Haines 07:28, 29 March 2007 (UTC)

Placement of POV template

This article does not adequately reference the Genital integrity movement, one branch of which seeks to end medically unnecessary genital surgery on children with ambiguous genitalia. It speaks too much of "correction" as though surgically modifying the genitals of infants "corrects" anything. This surgery is usually done for the comfort of the parents. Has anyone read the John/Joan case? Often when the surgery is done on an infant, that child grows up and finds that either they identify with the gender opposite the one the doctor picked at birth, or that the surgery compromised their sexual sensation. I think more should be written about how the routine surgery affects intersex people. Joie de Vivre 14:59, 21 March 2007 (UTC)

There should be lots of sources to help at the ISNA's Bibliographies page. --MalcolmGin 23:44, 23 March 2007 (UTC)

I've read a few reports on these "branches" mentioned above. I think its critically important to "correct" genitals appropriately in intersex patients. It must be named "correcting", because there really is something wrong with normal development in DSD patients. Ambiguity, although not seen as the main source of gender dysphoria in intersex patients, can generate feelings of disparity in contrast to same-sex peers (Cohen-Kettenis 2005, P.; Zucker, K.J. 1999). Genital correction is done with great care, often considered as important as gender assignment in DSD patients. This cannot be seen as "routine" surgery, mainly because it involves serious discussions in expert gender assignment teams in children's hospitals. ---Chbse

Friends, these all seem to be good comments. The nice thing about NPOV means we don't have to decide which is the best way forwards ourselves, just report both suggestions -- let the reader decide. If we feel a case isn't adequately explained, we should add it ourselves, with sourced material, of course. Thanks Malcolm for the excellent link. Milton Diamond's Pacific Center for Sex and Society also has full texts of peer reviewed articles that are relevant. I'm busy on other projects atm, or I'd write up both cases mentioned here, I've seen excellent sources at the sites listed that cover both points of view. Alastair Haines 07:11, 29 March 2007 (UTC)

See Also: nessecity of 17β-hydroxysteroid dehydrogenase type 3?

When 5α-reductase deficiency is mentioned in the "See also' section, wouldn't you agree that 17β-hydroxysteroid dehydrogenase type 3 should also be mentioned in respect to testosterone biosynthesis disorders? ---Chbse

Sounds right to me, but I'm no expert and don't have time to find the sources. Boldly go ahead and add a peer-reviewed source on this, with some text that makes it comprehensible to non-experts. Wiki needs people like you Chbse, who know what's missing, where to find it, and can take a few minutes to write it up. The edit link is there for you to use. Click me, click me it says. ;) Cheers Alastair Haines 07:15, 29 March 2007 (UTC).

I'll do my best to contribute to this topic (and others alike intersexuality). Currently I'm a reseach student in the area of intersexuality and gender identity. I'll try to loosen up my every-day english and make it conprehensible for non-experts. Greetings. - Chbse

Added 17-beta-hydroxysteroid dehydrogenase deficiency to the list and removed testicular dysgenesis from the See Also list. Testicular dysgenesis is a synonym for gonadal dysgenesis. Can someone help me link 17-beta-hydroxysteroid dehydrogenase deficiency to a real topic? I've found it on Wikipedia; another article to contribute to :-). Greetings. Chbse

I like you Chbse! :D I'm a research student in ancient love poetry, but I've got kinda fascinated by intersex. If you'd be willing to be an "expert contact" for me I'd appreciate it, my email is haines@alastairs.com. Check my user page and drop me a line, if you trust my professionalism (no spam, no referals without consent first, acknowledgement of anything you tell me, citation if you publish it ;). I'll put some thought into where we can link the 17-beta-abracadabra, once I understand what you teach me about it. ;) Ciao. Alastair Haines 11:51, 29 March 2007 (UTC)

Male pseudohermaphroditism due to 17-beta-hydroxysteroid dehydrogenase deficiency is here at Wikipedia. There are likely to be comments regarding the use of ps-herm of course, it's such a hopeless word for non-specialist discussion. I'd recommend we try to avoid the word in the Wiki context, though it does have it's place in certain limited contexts. Perhaps you could start a new article at a higher level than 17-beta-etc, but more specific than intersex in general. Knowledge is the enemy of prejudice! Let's help people understand our brother/sister/special friends. To start a new article make a red link, click on it and away you go! :D Alastair Haines 12:09, 29 March 2007 (UTC)

"at a higher level than 17-beta-etc, but more specific than intersex in general."? I'm sorry, I'm just a low-life dutchman with hardly any language skills ;-). I just started working on this site, and thouroughly enjoy adding to discussion and articles, but a haven't had the time to read all there is to read on adding articles, levels of articles etc... sorry. I'll try making a neutral article on 17-beta-hydroxysteroid dehydrogenase deficiency-3. Greetings Chbse 14:26, 29 March 2007 (GMT+1)

Language

Having separate (and non-consecutive) sections for "Language" and "Nomenclature" seems redundant. — Emiellaiendiay 05:08, 26 May 2007 (UTC)

new sci am article

"When a Person Is Neither XX nor XY: A Q&A with Geneticist Eric Vilain," May 30, 2007.[1]

"Eric Vilain discusses the biology and politics of mixed-sex individuals, arguing that terms such as "hermaphrodite" and "intersex" are vague and hurtful." --Ty580 23:36, 4 June 2007 (UTC)

Is "Congenital Adrenal Hyperplasia" in 46,XX females, more-or-less the same process as "Masculinization" in 46,XY males?

The article makes the following statement regarding Congenital Adrenal Hyperplasia, (hereinafter, "CAH")....

CAH is a genetic disorder in which the adrenal glands "while trying to make cortisone, may make an unusually high level" of masculinizing hormones. When CAH occurs in an XY embryo, this is not an intersex condition, but amongst XX individuals it is one of the most frequent forms of intersexuality.

Due to a defect in the enzyme that synthesizes adrenal hormones, a blockage in one synthetic pathway will occur, causing excessive production of androgenic hormones in a different pathway, virilizing an XX fetus in utero. Genitalia may appear completely masculine, or it may be ambiguous.

[Emphasis added]

My question is whether the typical "masculinization" process which occurs in utero in 46,XY individuals is also the resulting effect of the "blockage in one synthetic pathway".

Are the 2 processes more-or-less identical, or does an entirely different process occur in the masculinization of 46,XY males?

--Please let us know, as it could clear up possible ambiguity in the article.

Pine 22:04, 25 July 2007 (UTC)

Some aspects of the "masculinizing process" are the same, and some are different. The main aspects that are the same are the principal masculinizing hormone (testosterone) and the mechanism of its actions on the target tissues of the external genitalia (reduction to dihydrotestosterone by 5α-reductase and binding to the androgen receptor). The main aspects that are different are the sources and amounts of the testosterone because a typical XY fetus with CAH has testes and a typical XX fetus with CAH does not.

Are you trying to improve your understanding of this condition or the wording of this article? The article has many flaws and inaccuracies, including a glaring error of simple fact in the first sentence you quoted (the adrenal hormone that cannot be made efficiently is cortisol, not cortisone). Congenital adrenal hyperplasia and congenital adrenal hyperplasia due to 21-hydroxylase deficiency are articles on the topic written with a bit more expertise. alteripse 11:11, 26 July 2007 (UTC)

Cleanup made

I've made a general cleanup of the article. The motivations of each edit is seen in article history. Mikael Häggström 07:50, 3 August 2007 (UTC)

The boy with "one testis and one ovary"

I, perhaps temporarily, moved the following section to here, because it requires further discussion:

According to the New England Journal of Medicine, vol 338, p 166, physicians in the Western General Hospital, Edinburgh, Scotland have reported on a child with a penis, one testicle, and an ovary and fallopian tube instead of a second testicle. Some of this child's body cells are XY (male), and some are XX (female). The child was conceived as the result of in-vitro fertilization, and it appears most likely that two embryos, a male embryo and a female embryo, fused before or soon after embryos were transferred to the mother's uterus.

It has a reference, and that's good, but it's still too unreasonable to be completely true. Even if there were two different cell lines in the body, the result would still not deviate from the more common case of mosaicism, because the anti-müllerian hormone produced in the male part still would inhibit the Müllerian duct of the other part. Thus, the other part, too would develop to a male one - unless there is a complete block in the blood flow between the two parts, which however would render the whole body inviable.

Therefore, I think this text requires an external link to where it was found, so a scrutiny of that source can be done. Alternatively, another source is needed. However, no such esult was found in NCBI on the search for e.g. "Western General Hospital testis ovary". Mikael Häggström 11:59, 3 August 2007 (UTC)

I've seen charts of multiple patients with 1 testis and 1 (dysgenetic, but specific) testis/ovary. Mosaicism is the leading cause of 'ambivalent' gonads. 46XX/46XY or 45X/46XY often have dysgenetic gonads. Antimullerian hormone can be excreted in lower levels than normal, resulting in less degradation of mullerian ducts and the formation of eg.: 1 testis and 1 ovary. This is still quite rare; most mosaic patients have ovotestis or streak gonads (more specific in 45X/46XY). —Preceding unsigned comment added by Chbse (talk • contribs) 10:16, 15 November 2007 (UTC)

Ovotestis, neither testis nor ovary

I found one reference of such a case. Perhaps it's the one mentioned above: True hermaphroditism with XX/XY sex chromosome mosaicism: report of a case. De Marchi M, Carbonara AO, Carozzi F, Massara F, Belforte L, Molinatti GM, Bisbocci D, Passarino MP, Palestro G.. However, following the logic presented above, there aren't testes and gonads at the same time. Rather, there are ovotestes, something in between. Mikael Häggström 12:15, 3 August 2007 (UTC)

Children not genetically similar to mothers

I move this unreferenced claim here for discussion:

There have been about 40 known cases worldwide of humans reproducing naturally and producing offspring with absolutely no genetic similarities between mother and child.

First, how can this be possible? Does two sperm cells form an alliance and then throw the nucleus of the oocyte out of the cell, and then fertilize it together?

Second, what has this with intersex to do with? Mikael Häggström 12:38, 3 August 2007 (UTC)

It was kind of you not to delete it outright. Sounds impossible. Jonathan Tweet 15:04, 4 August 2007 (UTC)

It could refer to mosaicism, where some of the cells might not match the mother. But still, what does this have to do with the intersex condition? Now, someforms of intersex have a mosaic form, such as XXY/XY. In that case, there would be less chance of retardation and infertility since there are some unafflicted cells. --24.167.191.111 03:25, 2 September 2007 (UTC)

incident of partial masculinization

Does anyone know where I can find information about the dramatic case where boys started menstruating through their penises at puberty? I think it was in Puerto Rico or some other Caribbean island in the mid-20th century, and female fetuses were exposed to male hormones through beef (I think?). The XX fetuses developed male external genitals and were raised as boys, but they started menstruating on schedule at puberty. If I can find information, it would be a good add to this page. Jonathan Tweet 15:03, 4 August 2007 (UTC)

Read the article of Progestin-induced virilisation. It doesn't mention that specific occasion, but it must certainly be the case. Mikael Häggström 16:15, 5 August 2007 (UTC)

That most certainly is not the case. alteripse 17:14, 7 August 2007 (UTC)

Well, on second though, that last statement of mine might have been a little too hasty. However, except that statement that it was administered in beef (even if they would feed cows with progestin, it shouldn't be accumulated to such degree), what makes it impossible? The route of administration simply was from somewhere else - a mad scientist perhaps. Very improbable, of course, but possible. Mikael Häggström 16:52, 8 August 2007 (UTC)

What makes it impossible is that progestins can interfere with masculinization but will not make an XY fetus grow a uterus nor will they so virilize an XX fetus that it would be assigned and raised as a boy. No uterus, no periods. Period. alteripse 20:31, 9 August 2007 (UTC)

That's not what the main article says. It says "ovaries and uterus or uterine tract are present, though in extreme cases of virilization there is no vagina or cervix" and "Sometimes, the virilization is as advanced that the child is given a male identity at birth[1]. However, it is very unlikely that the condition goes undiscovered until puberty".

So you're saying that this is false. You're sources may be true. And if so, I even beg you to correct the article with the right information. Mikael Häggström 08:52, 10 August 2007 (UTC)

Why not just intersex?

Why not have the article named "intersex" instead of intersexuality. The intersex condition is not a sexuality nor a lifestyle as implied by the +uality ending. --24.167.191.111 03:20, 2 September 2007 (UTC)

Intersex is a person. "ality" means to have a state of the root word. The article is about the state, not the people. Like WP has Diabetes, but People with diabetes is sometime else. --Ephilei 02:54, 6 October 2007 (UTC)

Also, -uality does not denote a "lifestyle" - homosexuality, for example, is not a "lifestyle," despite biased political statements to the contrary. --Cheeser1 04:39, 6 October 2007 (UTC)

Percent of population

I'm no expert, but according to Klinefelter's Syndrome, a kind of intersexuality, XXY affects 1 in 1000 "males" or more. Or, 1 in 2000 humans = .05%, not including many other types of intersexuality which is already much greater than .018% in the intro here for all types of intersex. I've read as high as .5% or 1%. The number of intersexuals is debated heavily, so I suggest the article should convey that debate. --Ephilei 02:42, 6 October 2007 (UTC)

Just to add some juice to the discussion of epidemiology and Disorders of Sex Development (formerly intersex): how do we define DSD/intersex? The international consensus on DSD (Houk et al 2006) is not really clear in this definition. There's a classification that includes cases with ("normal") Turner Syndrome and Klinefelter syndrome (which are FAR more prevalent) as well as more "pure" (non-chromosomally abnormal) DSD syndromes: androgen insens. syndr., gonadal dysgenesis, testosterone biosynthesis disorder etc. etc. etc. Where do we cross any line at all when applying epidemiology: (sex-) chromosomal disorders have an obviously direct chromosomal effect on gonadal sexual differentiation and thus a chromosomal effect on genital development, while the "more pure" DSDs obviously have a more direct effect in/on gonadal/sexual/genital differentiation. How can we present this definition of DSD and how can we show clear epidemiological results/numbers concerning this definition in the Intersexuality article in a NPOV way? Ideas anyone? Chbse 20:49, 29 November 2007 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)