Austen Crowder

Am I intersexed? Who cares!

Filed By Austen Crowder | December 03, 2009 3:00 PM | comments

Filed in: Living, Transgender & Intersex
Tags: intersex, Questions, transgender

Did you get a genetic test to see if you're intersex?medium.jpg

I get the question once every few months, usually from a well-meaning and honestly curious person. It's an interesting question, as well as a bit of a hot-button issue within the transgender community. I mean, who wouldn't want to know if there was a genetic reason for their transgender feelings, right? Being intersexed is no big deal, after all, and is just another part of the tapestry we call gender. Getting tested wouldn't do anything to affect my status as a woman.

However, I take a different tack when answering this question, mostly because I sometimes doubt the reason behind it. This innocent question carries with it the idea that transgender identities must be pathologized, categorized, and explained in scientific terms. Since most transgender people are by necessity self-diagnosed, there is always a shadow of doubt cast upon the process. "Are they really transgender, or are they lying to themselves?" The question never really goes away, and people are always seeking an answer that falls within their own prejudices.

Thus, I find the best way to tackle it is to frame the answer within the words usually featured alongside it: "I hope it will never be something you regret doing."

Trans people have an uphill battle on pretty much every front. If it's not discrimination, family issues, acceptance in society, or simply just not being beat up, killed, or otherwise hurt because of who they are, they must also battle the medical community that's sworn to serve them. Despite the fact that the APA and AMA both accept the diagnosis of Gender Identity Disorder, and despite their recommendation that transition is often deemed medically necessary, our diagnosis is almost always cast in a shade of doubt.

The thought that occurs both in the minds of professionals and casual observers remains, "Well, sooner or later they could live to regret it," and that is oftentimes enough to deny care to transsexuals. For example, there are exactly two doctors in Indianapolis who deal with transgender patients' needs, and both are difficult to find without knowing somebody who knows somebody. A quick search for "Rhinoplasty," in contrast, returns 58 results. While this certainly not a fair comparison, it does paint in broad strokes just how little attention the mainstream medical community pays to the needs of people like me.

More appropriate for our situation would be scoliosis, which serves as a perfect counterexample of how the medical community usually treats maladies. Everyone is checked for the disease, as it can cause disfigurement, paralysis, and in extreme cases death. When a case is discovered, experts immediately work to fix the problem, and the treatments are covered by insurance. Scoliosis falls into the regular medical model: we can clearly see the problem, we can clearly see the results of non-action, and can determine that action will have a net positive effect.

The only difference between scoliosis and gender identity disorder is that we cannot clearly observe the symptoms. People with GID bear no external markings, no identifiers, and no symptoms beyond what is going on between their ears. Medical professionals have devised tests that control for misdiagnoses such as schizophrenia or borderline personality disorder, but for the most part GID is a self-diagnosed issue. Despite not having noticeable symptoms GID brings with it tangible consequences for non-action: depression, self-image issues, suicide. Two in three transgender people attempt suicide. One in three succeeds. We can see the results of non-action, and we can see that action will have a net positive effect, but the symptoms escape us.

This lack of tangible symptoms throws the whole medical model into a tizzy. Trans people are often required, either by social pressure or by the medical community, to go to extreme lengths to prove their diagnosis. For example, I saw four different therapists before I found one willing to talk about my gender issues seriously; the first three dismissed my problem as transvestitic fetishism without even considering GID, and the fourth denied my diagnosis because I "didn't express enough feminine traits as a child." And even when I did finally get my diagnosis, and my hormones, and permission from the government to change the identifier on my license, the shadow of doubt is still cast over my identity as a woman. "She may still regret being a she," the logic goes. "Sometime, somehow."

Thus, people reach for a surefire diagnosing tool, even though no such tool exists. Genetic testing combines the scientific finality of chromosomes with the reverence of concrete diagnoses: it seems that it's easier for people to "get it" if they know that the transgender person is between genders chromosomally.

I feel that these genetic tests further aid the pathologization of GID in our society. The unspoken assumption of these genetic tests is actually moderately sinister: "If she's actually intersexed, or if she's chromosomally female, that explains everything and makes it better." I've seen it with a few other trans women deal with this issue, and I worry about the unforeseen consequences of putting up an intersex identity as an excuse for being transgender.

Would being intersexed somehow make me more of a woman, or explain that something really was wrong me to begin with? I don't think so. I'm transgender: I know this because my brain tells me that I am. An intersexed diagnosis would change nothing. Part of being trans is learning to have the resolve necessary to say, "This is who I am, and that's that." I've had to battle my family, my friends, my therapists, and my doctors to get this process rolling, and in the end most everyone has agreed that it has made me happier. Yet there is always a doubt in people's mind, and on occasion people do step up and express it. I get the feeling that if I could respond with "Well, I'm actually not a genetic male" that these fears would mostly be allayed, but what good would that do me? I'd still be transgender, one way or another, in the eyes of society.

I don't feel that I need to pathologize or rationalize my gender issue via a genetic test for it to actually exist. I fought depression and dysphoria with my body for most of my life and eventually worked up the courage to face it. When I started hormone therapy, the depression was mostly solved, leaving me free to feel like myself for the first time in my life. As far as I'm concerned, this alone proves the fact that I'm a transgender woman, and this is the right decision.

I will eventually have a genetic test - it is the future of medicine. However, I will not be typed for sake of discovering the status of my sex chromosomes. I don't need a scientist to tell me I'm a woman, just like the questioner doesn't need a genetic test to know their gender.


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Intersex is a tender issue, like testing a fetus for Down Syndrome. Though it could lead to proof for insurance coverage; it could also lead to early fetal testing as a "medical necessity" abortion. On the flip side of the coin....What would happen if a Bio Heterosexual male through testing was found to be intersex? Now there is a paradox for the AMA.

You should have been tested as part of the diagnosis.

Because people who are Intersexed cannot have GID.

It's just one of the ridiculous sillinesses in the situation that whether you have a "mental illness" or not depends on whether you have oddities in your chromosomes or endocrinology.

Under the ICD-10, anyone who is intersexed cannot be Transsexual (F64.0).

Transsexualism (F64.0) has three criteria:

1. The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment

2. The transsexual identity has been present persistently for at least two years

3. The disorder is not a symptom of another mental disorder or a chromosomal abnormality

Under the (US) DSM-IV-TR, anyone who is intersexed cannot have GID (302.85), but may be diagnosed with GIDNOS (302.6) instead.

There is no Standard of Care for GIDNOS, and no agreed-on therapeutic regime. Depending on the luck of the draw, you may be fast-tracked, shoehorned in to a SOC-like transition, or denied hormones, surgery, or anything else.

There are medical issues too, your response to hormones may be anomalous. You could be at a risk of cancer from the usual HRT regime, unless you have surgery first. There are dozens of different IS conditions, and while most are irrelevant, some are not.

Finally, there are legal complications too. You may be declared biologically of the target gender before treatment commences. In which case, your surgery may not be Sex Reassignment Surgery by the letter of the law, so may lead you to be denied documentation changes.

I'm in that position, by the way. The UK Gender Recognition Act is wonderful if you're TS - allowing change to documentation even without surgery. But for IS people, who cannot conform to the required ICD-10 F64 diagnosis - even if they're post-op - it's been a disaster.

“3. The disorder is not a symptom of another mental disorder or a chromosomal abnormality”

um... can you have GID and be IS? The book says one thing, the reality is... the reality.

I was gendered as male at birth...after a few days of negotiations (beats me, I was like days old and busy figuring out the important things in life like eat, sleep, pee and poop) they said ‘male’ on the second try. So I was raised ‘male’. At 28 they found out my normal hormonal patterns were predominantly female and not male. While doing lab tests they found out my normal A+ blood would have O- white blood cells mixed in with it. So, obviously a genetic issue and no need to do a karyotype test.

I do have GID and my care givers realize that…well, that I’m ‘complicated’ both physically and psychologically and they often have to rely on me for information as to my conditions.

But am I transgendered? Yes I am and am transitioning from ‘male’ to female. Some think that its easier for me to do this but… well, its not. Its just as hard for me as for everyone else out there to transition.

Does the insurance cover anything because I am IS? Nope, it’s a pre-exsisting condition. If it would have been discovered while I was a minor it would have been but as an adult I’m treated the same as any other transgender person and so far every issue I’ve delt with turns to being transgender and not intersexed. It seems that you can grow out of being IS but not TG. Go figure.

Maybe things are different here in America, but an insersex condition was not one of the prerequisites of beginning a hormone regimen for me. I mean, it was a one-off question early in the therapy process, but once I answered the question about physical genitalia that was all she wrote.

I actually prefer this to the "must test for any intersex condition" school of thought. Yes, I understand that intersex conditions can create complications in therapy, but at the same time I disagree with a differentiating diagnosis for IS people who desire transition.

However, I speak from an armchair-psychologist position on that issue, so take that with a grain of salt. :)

I wholeheartedly agree; whether or not my being trans can be attributed to an intersex condition shouldn't have any bearing on how legitimate my identity is considered, how the medical world treats me, or how much respect I get from the general public.

"Part of being trans is learning to have the resolve necessary to say, "This is who I am, and that's that." "

Exactly!! That is a major part of my journey.
Even nine years after my coming out.

I'm glad I transitioned and I consider myself fortunate. But, be very sure you want this.
It is not for the faint of heart or the curious.
It can save you or it can consume you.

It saved me.:

:smile::

In response to the question "Who cares?", I respond "Not me." In fact, I don't give a whit about anything in this post and I don't think it has anything to do with the lives of gay, lesbian or bisexual people.

We spent half a century persuading elite opinion in the Western world that gay was not a psychological disorder, that gay was not a "third sex" and that gay men are fully men and lesbians are fully women. Now, in stroke of political idiocy, we have told the world that "gay" is in the same category as "T" including intersexed people and people with Gender Identity Disorder.

This is a further illustration of how ridiculous it is to force "T" into the "LGB".

Yet some transgender women are lesbians and some transgender men are gay. Do they not fit into your neatly categorized ideal of community?

I do not view transfolk as having a 'psychological disorder.' Being born female in a male's body could best be described as a physical issue that can be accompanied by the psychological troubles that this genetic mis-wiring might cause for them. But GID in itself is not psychological, in my opinion.

"Yet some transgender women are lesbians and some transgender men are gay. Do they not fit into your neatly categorized ideal of community?"

They those specific people are part of the gay community because they are gay. It doesn't follow that all trans people are part of the gay community. You know, there are some citizens of Slovenia who are gay. By your logic, that means Slovenians as a group should be part of the gay community and we should be the GLBS community.

As far as GID, I don't care if it is a physical disorder or a psychological disorder or some combination of the two. It is a disorder and there is no reason on this earth why gay people - who have just spent 4 decades persuading people that homosexuality is not a disease - should be identifying with that.

You refer to gay transmen and lesbian transwomen as "specific people [that] are part of the gay community because they are gay." And then you proceed to tell us how different trans and gay people are. On top of this I refer to my many years of being trans in a gay community and note that very few of my gay male friends accept me as one of them. Most cannot get past the fact that I am trans and gay - at the same time. You, like most gay people, want separate communities on one hand and on the other hand you insist that I am still gay and am one of you. I don't buy any of it.

I don't think it is that complicated. You are part of the gay community b/c you are gay. Period. Full stop. I am sorry you have friends who have a hard time w/ it, b/c logically and morally, they shouldn't.

However, that does not mean that every other characteristic that you possess is comparable to sexual orientation and it doesn't mean that whole groups of people defined by those other characteristics are suddenly part of the gay community. For example, in addition to being gay, you may be right-handed, brown-eyed, a socialist, and a bus driver. That you are these other things doesn't mean that all right-handed people in the world, all brown-eyed people, all socialists, and all bus drivers now have a claim to being part of the gay movement. It is not exclusionary or mean to say that. It is sanity.

Whatever other reasons there may be to justify the creation of "LGBT", the argument that "I am gay as well as trans" fails.

If I didn't know any better, I'd say you were trolling.

Fortunately, I've already written no less than three articles on the issue, the three URLS of which i shall repost here. I think these articles will do a better job of countering your off-topic argument than a simply taking the bait and jumping in headlong into a different subject entirely.

http://www.bilerico.com/2009/11/take_a_tip_from_the_lions_or_why_i_dont_like_the_m.php (In which I make my argument)

http://www.bilerico.com/2009/11/counterpoint_trans-inclusion_is_distracting_to_lgb.php (In which I make your argument)

http://www.bilerico.com/2009/11/putting_on_the_brakes.php (In which I wrap it all together.)

I had read all 3 of those pieces. None is persuasive. You asked "who cares" and I answered. That is not OT or trolling.

You just want to establish "LGBT" as a universally accepted premise, not the subject of the debate itself. A lot of LGBs are not prepared to be railroaded in that manner.

I'm really not fazed by your lack of interest in the subject: after all, I agreed with you when you said, "I don't think it has anything to do with the lives of gay, lesbian or bisexual people." I'm a trans person, this is a trans issue, and on a lgbTq website that's fair game. Just because it's not within your LGB interest set doesn't mean it needs to be censored from the website, or otherwise made to fit the needs of the LGB community. I'm not trying to railroad you. I'm trying to participate in a discussion. The fact that is has nothing to do with your struggles as an LGB person is beyond my control, and frankly beyond my interest.

My point of posting those three pieces was to move the primary argument of your comment -- "this doesn't have anything to do with LGB people so we shouldn't have T's in the LGB community" -- to a more appropriate forum. What you are trying to perform here is commonly referred to as a "threadjack" (http://www.urbandictionary.com/define.php?term=Threadjack).

If you'd like to continue a conversation about intersex versus transgender identities on this comment forum, I'd be happy to have it. However, you have yet to make any actually commentary on the article itself, instead taking the time to soapbox for a tangental topic of discussion. In my book, that's just plain rude.

If you don't like talking about transgender topics, don't. It's really quite simple.

Well I didn't mean to be rude. But the worst thing I have been accused of here was to have unintentionally hijacked a comment thread. What you and your fellow trans activists have done is to intentionally hijack a movement.

The point was not that you shouldn't be able to discuss your issues. The point was that your post illustrates just how separate Ts are from LGBs. Your problems as set forth above are not part of the lives of LGBs. It is like Bilerico suddenly started allowing regular posts by Basque separatists and their issues. I am sure they are serious issues, but who in their right mind would think that they should be married with the gay rights movement?

I realize that I'm commenting almost 2yrs later, but I just came across this blog post, and I felt the need to leave my 2 cents. "What you and your fellow trans activists have done is to intentionally hijack a movement." By your reasoning, I think I can claim that "what gay activists have done is to intentionally hijack a community." The community to which I refer, is of course the original LGBTQ community, the "introvert" community. You know... from back when neither scientists, nor society, differentiated between "LGB" (as you put it) and T... back when we were all just mentally ill, sexually depraved, introverts. The reality is that the people that today go by LGBT have always been living, working, and fighting for existence in a cloud-like community.

Moreover, there are individuals that may identify as both LGB and T, because they identify their gender as being both inside and outside of one of the gender binary. I'm an example; I'm butch. Should I consider butch a subset of the gender "woman"? If the answer's yes, then I'm a lesbian. However, should I consider butch a gender of its own, then I'm not a lesbian. In the latter case, I'm transgendered, but not a member of either gender in the perceived gender binary; using the latter definition, I'm T, but not L, G, or B.

I'm sorry that people like you can't see past your little prism. I'm sorry that we have people in our community who don't understand that human sexual behavior has more fluidity than the LGBT acronym can convey. Some people are a mixture of L and T. Using LGBTQ recognizes that fluidity and cohesiveness. On a cloudy day, it's not so easy to tell where one cloud ends and another begins, or if it was all just one cloud to begin with.

I'm struck by the fact that a physical test for intersex conditions is not a standard part of the medical model for trans people even though the DSM and ICD differentiate the diagnosis on that basis. I suspect it may be that the medical community agrees that intersex status doesn't really make much difference when you have gender dysphoria and wish to transition.

Personally, having fathered 2 sons, the chances of being measurably intersex is very slight (although not impossible) so in my case it would probably be a big waste to have my chromosomes tested. That said, if I could prove my transsexuality is based on a measurable intersex condition, health insirance coverage would be more likely, even if it's not assured.

There's a more-than-decent chance that these tests _are_ required, in some areas. However one must remember that transgender care is often a slapdash affair, built from doctors who much work outside of the regular medical model to get patient's needs covered by insurance, approved by pharmacies, et cetera.

Many transfolk get their medical needs covered because their doctors falsify their records. Why would they sign up for a test that could possibly give proof to insurance companies that we're getting transition care, thus making most of our medical needs easily deniable?

I could definately see a karotyping as a good medical practice. However, given teh way insurance works with trans people right now I doubt it'll happen anytime soon.

Out of necessity I have to go to a community mental health center to see my new psychiatrist. During my first visit a month ago, I went through all my details he must know, including that I am trans. I've dealt with doctors being clueless before so I felt prepared for whatever his reaction would be. After I nonchalantly tell him, he looks at the floor, gulps, looks up and says "so, how long have you felt like a woman?" At which I squealed and laughed. I've spent so many years actively convincing people of my identity (gay transman) and now this doctor thinks I'm a pre-everything transwomen because I pass so well (apparently). He apologized profusely afterwards, but all I could do was laugh at the absurdity of all of it. He tried at least, my sister says and I agree, he made a valiant effort, particularly compared to other tactless and creepy doctors. And he still got it all wrong.

Trans and intersexed conditions so much more complicated than anyone realized, I think. And we're just finding out about all the complexities such as genetic mutations, hormone imbalances, and brain differences that occur. I have never really cared whether I am intersexed, but I've always suspected I am. My body produces way too much testosterone on its own that I started experiencing masculinization after puberty hit me with feminization. I take a really small dose of testosterone compared to other transmen and I have take it in really small doses so that my system doesn't get out of whack. I don't know how this fits into being intersexed and none of my endocrinologists have ever bothered to find out why, so I guess that's why I don't really care either. I am also a flaming homo, but I guess we're not really talking about that now. ;)

I forgot to mention that as a young "girl" I was much stronger than anyone my age. In fact, I was often 4-5 years ahead in terms of physical strength and competed with boys only until 12 because the girls couldn't keep up with me. It was fun to win, I admit, but I always knew I was very different because of this.