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Intersex

Intersex – in the medical literature also called Differences of Sex Development (DSD) – is a collective term for various congenital medical conditions in which physical sex characteristics (chromosomes, hormones, gonads or genitalia) deviate from the typical male or female pattern. These are biological variations on a binary sex system; intersex is emphatically not a 'third sex' and is separate from gender identity and sexual orientation.

Important to note first

In public debate, intersex conditions are regularly – usually by people not affected – brought up to 'prove' that biological sex is a spectrum. That is a misconception, rejected within the medical world and by many intersex organisations. Human reproductive biology is based on two gamete systems: small gametes (sperm) and large gametes (egg cells). There is no 'in-between'. DSDs are deviations from the usual developmental route to one or the other; they do not define an additional sex.

The often-cited 1.7% estimate (Anne Fausto-Sterling) has been firmly criticised in later scientific literature, including by Sax (2002), because it includes conditions that do not concern sex determination itself. A stricter, medically more accepted estimate is around 0.018% – less than two in every ten thousand births.

Which conditions fall under this?

Intersex/DSD is not a single condition but a collection. Examples include:

• Klinefelter syndrome (XXY) – chromosomally male, with variable phenotypic consequences;
• Turner syndrome (X0) – chromosomally female, with growth and fertility problems;
• Congenital adrenal hyperplasia (CAH) – overproduction of androgens, particularly relevant in XX individuals;
• Androgen insensitivity syndrome (AIS) – XY individuals whose tissues do not respond to androgens;
• 5-alpha-reductase deficiency – atypical development of male external genitalia.

The large majority of people with a DSD identify naturally as male or female, generally in line with the dominant biological signal. Being intersex does not make someone transgender or non-binary.

Distinction from the transgender discourse

Intersex is a bodily condition; transgender refers to a psychological self-identification. The two are frequently mentioned in one breath in activist sources, but substantively they have hardly any overlap. Intersex organisations regularly object to having their cause (the bodily integrity of children with DSD) piggy-backed on gender-identity debates they did not ask to join. The acronyms AMAB and AFAB – from activist usage – therefore do not fit well with intersex conditions, where birth registration itself is sometimes uncertain.

Medical care and human rights

A long-running debate concerns non-necessary 'normalising' surgical interventions on intersex infants and young children. For decades such interventions were carried out routinely to make the body visibly match a chosen sex registration. Intersex organisations and human-rights bodies, including the UN, have criticised this practice as an infringement of bodily integrity and self-determination – precisely because the child itself cannot give consent. In the Netherlands the guidelines have been tightened in the direction of restraint; a legal prohibition is still lacking.

Intersex and identity

Some people with a DSD see their condition as part of who they are and speak openly about it. Others experience it as a medical history that need not be an identity matter. Both positions are legitimate. What matters is that the medical and human reality of DSDs is not instrumentalised by outside parties – for instance for argumentative purposes in other debates.