Anne Fausto-Sterling, Sexing the Body, chaps. 3, 7

Posted: Wed, Mar 19, 2025

In-Class Activity

  • What was the most surprising thing you learned about the biology of sex (from the documentary, from the Karkazis video, or from the readings)?

Sexing Genitalia

Intersex People

Fausto-Sterling’s (2000) estimate: 1.728 in 100

Some examples:

  • Congenital Adrenal Hyperplasia (CAH): in XX children, masculine-appearing genitalia
    • Note the kind of language we use to describe this: “For instance, the clitoris may be enlarged and resemble a penis. The labia may be partly closed and look like a scrotum. The tube through which urine leaves the body and the vagina may be one opening instead of two separate openings.” (Mayo Clinic)
  • Androgen Insensitivity Syndrome (AIS): in XY children, female-typical genitalia
  • Turner Syndrome: 45,X0
  • Klinefelter Syndrome: 47,XXY
  • Jacobs Syndrome: 47,XYY
  • Trisomy X: 47,XXX
  • … and more
  • PCOS? (debated)

Nomenclature: Disorders of Sex Development (DSD) vs. intersex variations

The Traditional Model for Managing Intersex Newborns

  • Sex is a clear-cut division between males and females.
  • Those born with “ambiguous” genitalia have a “true” sex waiting to be discovered by science/medicine.
  • It is medically urgent that the ambiguity be surgically “fixed” early on.
  • While some physicians now support some transparency, this is a very recent and very limited development.

Why the Urgency?

  • Parents: Suzanne Kessler reports that “the physicians [that she interviewed] acknowledge that diagnosis, gender assignment, and genital reconstruction cannot be delayed for as long as two years, since a clear gender assignment and correctly formed genitals will determine the kind of interactions parents will have with the child. The geneticist argued that when parents ‘change a diaper and see genitalia that don’t mean much in terms of gender assignment, I think it prolongs the negative response to the baby. . . . If you have clitoral enlargement that is so extraordinary that the parents can’t distinguish between male and female, it is sometimes helpful to re-duce that somewhat so that the parent views the child as female.’ Another physician concurred: parents ‘need to go home and do their job as child rearers with it very clear whether it’s a boy or a girl.’”
  • Gender identity development: According to Anne Fausto-Sterling, many physicians “emphasiz[e] that nuanced scientific understanding of anatomical sex is incompatible with a patient’s need for clear-cut gender identity.”
    • Luckily, on John Money’s extraordinarily influential theory, gender identity is highly malleable during early childhood. So, the theory goes, if surgical interventions are completed in time, intersex children will come to develop gender identities that align with the sex and genitalia they were surgically assigned.
    • But Money’s theory has been debunked by David Reimer’s case.
  • Sexual orientation development: With successful surgical interventions, intersex children will develop “appropriate” partner and sexual preference (i.e., PIVI).
  • Trauma of castration: Kessler writes, “Money suggests that if reduction of phallic tissue were delayed beyond the neonatal period, the infant would have traumatic memories of having been castrated. . . . Although physicians speculate about the possible trauma of an early childhood ‘castration’ memory, there is no corresponding concern that vaginal reconstructive surgery delayed beyond the neonatal period is traumatic.”

Why not Full Transparency?

  • Parents are usually told that their child has “underdeveloped” genitalia, as if all that needs to be done is to let the genitalia grow just a little bit more and the child will reveal themself as either female or male.
  • Information is also usually (partially or fully) withheld from intersex children themselves, even when they grow up. “An intersex child assigned to become a girl, for instance, should understand any surgery she has undergone not as an operation that changed her into a girl, but as a procedure that removed parts that didn’t belong to her as a girl.”

Why? Pp. 64–65.

So, How Do You Determine the “True” Sex of an Intersex Newborn?

Patricia Donahoe’s recommendations are highly illustrative: “Genetic females should always be raised as females, preserving reproductive potential, regardless of how severely the patients are virilized. In the genetic male, however, the gender of assignment is based on the infant’s anatomy, predominantly the size of the phallus.”

  • If the child has the potential to bear children later in life, they should be assigned female and raised as a girl.
  • If no, we’re in the business of male sex assignment, and it comes down to penis sizes:
    • The child should be assigned male only if they have a “normal”-sized penis (p. 57).
      • “Young boys should be able to pee standing up and thus to ‘feel normal’ during little-boy peeing contests; adult men, meanwhile, need a penis big enough for vaginal penetration during sexual intercourse.”
    • But if their genital is not large enough for a penis but too large for a clitoris, clitoral reduction (or even removal) should be performed.

Some More Recent Developments

  • In July 2020, Lurie’s Children Hospital in Chicago became the first U.S. hospital to apologize for performing intersex surgeries.
  • A few months later, Boston Children’s Hospital also announced that it “will not perform clitoroplasty or vaginoplasty in patients who are too young to participate in a meaningful discussion of the implications of these surgeries, unless anatomical differences threaten the physical health of the child.”
  • In July 2021, New York City Health & Hospitals announced that they would defer all unnecessary intersex surgeries until the child is old enough to meaningfully participate in a decision.

Sexing Hormones

The “Sex Hormones”

  • There are not just two sex hormones.
  • The sex hormones are chemically similar and interconvertible.
  • Sex hormones are not just about sex: the brain, the lung, the bone, the skin, etc.
  • Sex hormones are not exclusive to each sex:
    • Everybody has both: “In a[ 1934] article variously described by other scientists as ‘surprising,’ ‘anomalous,’ ‘curious,’ ‘unexpected,’ and ‘paradoxical,’ the German scientist Bernhard Zondek described his discovery of the ‘mass excretion of oestrogenic hormone in the urine of the stallion‘—that cherished mythic symbol of virility.”
    • And they are functional! E.g., testosterone plays a role in ovulation.

Naming the Steroid Hormones

  • The “male” & “female” hormones: assumed to exist on philosophical grounds, to be discovered by science
    • Identification: measure effects of gonadal extracts on castrated animals
      • Testosterone ~ testes ~ cockscomb growth in capons (castrated male chickens)
      • The “ovarian” hormone ~ “changes in the cellular contents of the vaginal secretion of the rat or mouse” (M.U. & R.U.)
    • Purification: urine from pregnant women and Berlin police officers
  • “Androgen(s)” ~ men
  • “Estrogen(s)” ~ estrus

Steroid hormones may be a more neutral name?

How to Reconcile “Cross-Sex” Hormones?

  • The “heterosexual hormones” view:
    • “They’re just nutritional by-products with no connection to the gonads. (So suggested Robert T. Frank, who claimed that ‘‘all ordinary foodstuffs contain female sex hormone. An average-sized potato contains at least 2 M.U.)”
    • Others “argued that the heterosexual hormones indicated a diseased state. Although the men from whom estrogen was extracted appeared to be normal, they might, perhaps, be latent hermaphrodites.’ ”
  • The “bisexual” hormones view: “[In the 1930s,] Korenchevsky and co-workers referred to such hormones as ‘’bisexual’ and proposed to group both androgens and estrogens according to this property. Only one hormone (progesterone—from the corpus luteum) could they envision as purely male or female. They designated a second group as ‘partially bisexual,’ some with chiefly male properties, others with predominantly female ones. Finally, they proposed the existence of ‘true bisexual hormones,’ ones that cause a return to ‘the normal condition of all the atrophied sex organs . . . to the same degree in both male and female rats.’ Testosterone belonged to this group.”

Fausto-Sterling’s question: “Do sex hormones really exist?” (In what sense/way?)

Broader question: how should we conceptualize the biology of sex in a way that recognizes its complexity and messiness?