Feb 19 2013
Sex, Gender, and Sexuality: It’s Complicated
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21 Responses to “Sex, Gender, and Sexuality: It’s Complicated”
Excellent post Dr. Hall. And I’ll refrain from dragging the discussion to certain sociopolitical ramifications of this (particularly in this country) and rather just add to your story with a brief anecdote.
Last year on my pediatrics rotation we had a morning report every day. At one of them the attending came in and did the usual – posed a clinical question and asked the group to work through every nuance of it. In this case he started out by saying:
“You are in the delivery room and the mother delivers a baby. APGARs are 9 and 10. Otherwise no complications. You are the obstetrician and the parenst ask, ‘How’s my baby?’ How would you respond?”
Seemed confusingly straightforward. We asked all the standard questions and each time the attending said that the baby was supremely healthy from every medical standpoint. But he still kept pressing us. “What do you say to the parents?” Finally we agreed: “You have a very healthy baby! Congratulations!” The attending asked, “A healthy baby what?” Aha! We had all neglected to ask the sex of the baby. So now we asked.
He then hands us a few full color photographs taken of a baby delivered at our hospital just the previous day and asked us to make the determination. I think everyone can guess where this is going.
The genitalia were completely ambiguous. We all argued over whether it was likely a girl or a boy. We then discussed how to actually determine it and what the complications could be (including CAH). But the questioned remained – what do we say to the eagerly waiting parents who are expecting – and want – to hear that they have a healthy baby girl or boy.
The key principle the attending was trying to relate to us was that we should not commit to a sex/gender statement at that time, because that could lock the parents into something. We would have to stress that the baby was indeed healthy but that we would need to do a few further tests.
So yes, while a useful and generally quite robust tool dichotomizing gender/sex does in fact fail in many ways.
Is the point to parse language so finely that no outlier is left unmentioned or to build a social fabric with a valued place place for everyone? The notion that every aberration needs to be warmly nestled in language where it does not naturally fit is inane and ultimately unproductive.
Thanks for this. Some people seem unaware that there are a zillion unusual situations. Check OMIM. NR5A1 foul-ups are my favorite cause they figure into some adrenal disorders.
I do find it a bit disappointing that there need to be legal definitions, and particularly as relates to marriage exceptional people do show that any such definitions have problems.
I’ll grant that specific knowledge is important when doctoring, but I think I’d want non-medical examples to show it’s important in other situations. I see some convenience for many of us when shopping for clothes, but it’s not that important: We dichotomize them, but they live on a continuum. I’m not scared of the buttons being on the other side of the shirt, or if those sandals are marketed mainly to women, maybe that’s part of why I’m wanting my culture to be less 0/1.
I do admit to being curious about other people’s genes and genitals and desires, but I try to fight it, telling myself that it is usually not my place to pry. But that leaves me almost no mechanism to indicate to the other person that I’m open-minded, since I never mention it.
I would call it “indifference to our taxonomies”
Before the theory of relativity, astronomers using the best tools of the day could calculate many celestial events with extremely good accuracy, but some outliers persisted. We needed an entirely new theory to explain these outliers and show that they are actually not outliers at all, they just needed a more sophisticated understanding of physics to fully grasp. I feel like this is what has happened to modern theories of gender, and its a great thing that we are able to learn new things about all of human nature from a few less common but totally normal people.
The only reason to find out what’s in someone’s pants is if you want to get in their pants (for medical or sexual purposes) We could all be a little less interested. I do wonder how the medical community feels about having an ‘other’ category when asking for gender/sex. I know some countries are starting to allow a third ambiguous gender on identifying papers. Really just having M/F option doesn’t always give all the needed information to healthcare.
I agree Lost Marble.
In fact, it is often commented to me that my “Gaydar” is broken because I often don’t notice that people are gay (or even when men are hitting on me). I’ve even twice been to gay bars – with groups of people for a fun night out – and not realized I was in a gay bar till the next day when someone laughed at how oblivious I was. I don’t don’t think my gaydar is “broken” but I just care that little about whether you are gay or straight or whatever you may be. It simply has zero bearing on how I interact with a person (except in the two cases you mention and perhaps some other specialized circumstances that may come up, but the latter of the two is a moot point entirely since I am currently engaged to be married).
I think this gets a little easier to process with some historical perspective. Obviously, most people are born with unambiguous biological sex, and in turn most people’s sexual orientation is toward the (usually unambiguously) opposite sex. These facts have been basic organizing principles for human societies throughout history. Most societies have been pretty rigid in their gender role definitions and norms, which as I say usually, but not always, track well with biological sex.
There is obviously considerable variation in exactly what those social gender roles have been, and there are a few societies (before our very complex and fast changing modern era) that have had accepted gender roles in addition to the standard 2 (e.g., Native American “Twin Spirits,”) or have allowed for sexual relationships between men and boys (Sparta) or other variants. But it’s a recent phenomenon, in keeping with our post-Enlightenment scientific and liberal worldview, to at first discover or acknowledge (the existence of homosexuality has obviously always been known, but avoided), and then begin to normatively accept, the less common variations Dr. Hall discusses.
It is not surprising that it takes language, etiquette, habits and practices a while to catch up with previously unrecognized realities, and changing mores. I hope that people will be tolerant and sympathetic to the struggles lots of folks will have during this process. It takes some getting used to, especially for people raised with fairly rigid morality, which is strongly tied to gender role norms, but really for everyone who hasn’t much contemplated it all before. I had a professor in college who changed gender, and it did kind of freak people out at first, but ultimately it was okay. This was in the ’70s. Could not have happened much before that, I think.
@Lost Marble:
When I went through my security clearance paperwork, one of the government databases had 7 choices, 7! Due to the fact that this did relate to clearances, I was not allowed to peer more closely as they entered the data (knowledge of data structure is a key step to learning how to break a system), but I have for years now speculated on what the seven choices could be. Male and female are givens, and there’s probably either a hermaphroditic or neuter category. Two might be assigned to “male sex change” and “female sex change”. But that leaves two. Merms and Ferms (terms I’ve seen used to describe intersexed individuals who are mostly toward one side or the other)?
The invocation of paraphilias in the area of gender and sex definition does come off a bit odd to me. Outside of homosexuality, and possibly pedophilia (last I heard, there are studies showing that pre-pubescent children of either age generally register as female to viewers when isolated parts of their body other than genitals are shown, which implies that male homosexual pedophilia would be a rare thing, contrary to the stereotype of homosexuals going after very young boys), how many of them are relevant to the topic of gender or sex? Or is it more of a general sexuality thing that gets intertwined with it?
Bravo, bravisimo, William Lawrence Utridge
“I would call it “indifference to our taxonomies”
so would I.
“Are there parallels in animals?”
Could you provide some references to prove sex abnormalities and homosexual behavior in animals?
rmgw, my wife wants the compliments to stop because I’m becoming unbearable. And she’s right. I’m barely sufferable on a normal week, let alone when strangers on the internet say good things about me
“It’s complicated.” Yes! Which is why I appreciate this post, a good collection and discussion of some of the main complications. I think one can make all sorts of social and societal allowances and accommodations in how someone wants to be addressed or viewed, but the overall binary nature of humans is very important medically.
“Could you provide some references to prove sex abnormalities and homosexual behavior in animals?”
Your choice of the word “prove” portends mala fides, and your apparent inability to type “homosexuality” and “animals” into Google suggests you are at work. Nevertheless, here are some links to get you started:
http://www.yalescientific.org/2012/03/do-animals-exhibit-homosexuality/
http://www.cambridge.org/gb/knowledge/isbn/item5708830/?site_locale=en_GB
http://news.nationalgeographic.com.au/news/2004/07/0722_040722_gayanimal.html
http://pactiss.org/2011/11/17/1500-animal-species-practice-homosexuality/
And, as if to provide “balance”, here are some links to, well, the religious… erm… rebuttal:
http://creation.com/homosexual-animals
http://www.probe.org/site/c.fdKEIMNsEoG/b.4223027/k.4C29/Is_Animal_Homosexuality_Proof_that_Its_Normal.htm
“Probe Ministry” – faboulous!
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Davdoodles:
Indeed. It was clear he has an agenda and needs to demonstrate that homosexuality is a choice in order to maintain his worldview and faith. Because after all, the simple argument that homosexuality is inborn demolishes the notion that god must hate the act since god created homosexuals that way in the first place.
The best part though? I click on your probe ministry link (just ‘cuz) and quickly skimmed and came across this:
Bam. End. Of. Story.
Unless god created all these animals homosexual for some reason we are done, aren’t we?
Of course not. Let the rationalizations begin.
And so on. I won’t bother rehashing it, but you get the gist. It essentially involves around this incredulity that evolution would predict homosexual behavior. That’s the funniest part – they argue against the validity of inborn homosexuality by using a caricature of evolutionary theory; a theory they themselves thoroughly denounce.
It still sometimes impresses me the mental gymnastics these folks will go through.
@DugganSC- that’s interesting that there were 7, can’t think of what they all could be either. I have this image in my head that way off in the future when asked for gender there will be a graph, with male and female on the x-axis, neutral and androgyny on the y, and one can pick a point on the scatter plot.
@cervantes – I do understand the historical perspective, and that mind sets change slowly, which is why we have to slowly prod people to shed some archaic beliefs. To say ‘oh well, it’s always been this way’ is a cop out and seems contrary to what this site is about. (I’m not trying to accuse you of this attitude)
@Lost Marble:
I think also it sometimes becomes a matter of practicality. It’s possible that we may one day arrive at a point where we refer to ourselves as 73% male, 23% female, 4% otherkin, but at the end of the day, if there’s any significance behind the distinctions, we eventually wind up in a pigeonhole. Take skin color, or heredity in general. A person could describe themselves as “a light coffee brown, not unlike the surface of a cappuccino that has been dappled in mare’s milk” but for the most part, people get a single label. It makes it easier to collate data to, for example, indicate that due to one’s darker skin, there’s a higher risk of a Vitamin D deficiency. Similarly, if the maleness or femaleness of a given person matters, there comes a time when we have to pick categories. People won’t fit wholly into pigeon-holes — someone who’s “black” can be anywhere from a light brown to a purplish color and someone with “red hair” could range from a flaming red to strawberry blond to auburn (and does someone stay a redhead if they had red hair as a child, or their hair is red under certain lights or when bleached by sunlight?). On a complete side note, the divisions of colors within languages is a pretty fascinating one. Did you know that the Japanese don’t distinguish between green and blue the same way we do?
Incidentally, is there any consensus on what’s meant by “trans man” or “trans woman”? It has always seemed to me that the term gets used interchangeably, at least in common parlance, for whether the “man” or “woman” refers to the prior or current sex/gender. Makes it confusing sometimes. In person, it’s generally a bit easier to know (although I’ve once or twice gotten bit by mistaking a transvestite for a transexual, although fortunately no one took offense in those cases).
@DuganSC I do agree with the comment on practicality. In regards to trans-man/woman, I have only heard the man/woman part to refer to which the individual identifies as. So Trans-woman is a male-female-transsexual. I suspect that when it is used otherwise it is actually a misunderstanding of what the word is meant to mean.
Otherkin. There is a sexual identity that I have a hard time pretending to take seriously.
It is astonishing to me that this post, this post and this post got hundreds of comments, all together more than 500, yet the meatiest, most substantive, and most revealing of Dr. Hall’s actual thinking and grasp of the complexities on sex and gender, got less than 20. So I’m bumping it up. This was a good, evidence-based, science-based post on sex and gender. I referred to it multiple time on other threads in an effort to get people to recognize that Dr. Hall is not a trans-hating monster or cissexual. It’s been up for longer than 2 of the 3 other related posts. That’s plenty of time to try to understand Dr. Hall is actually coming from. But it didn’t happen. I suspect pure confirmation bias is the root cause, people want to believe Dr. Hall is a big, ignorant meanie. I see this post as proof that this is not the case.
So bump.
Unfortunately, other than a brief mention on the right sidebar of the latest post, quickly drowned out by ten more posts to the insanity in the other threads, this doesn’t do much to bump things. Although, maybe it’s for the best. Otherwise, me might spend the next year seeing those three articles at the top.