Intersex Gender Transition

Incidence

Persons born with most intersex conditions change to the gender other than their original sex-of-rearing at a much higher rate than the general population. However, the absolute number of intersex persons who change appears to be much less than the number of those without a demonstrable physical intersex condition who change.

Gender change in intersex persons may happen at any stage of life from infancy through late adulthood and in persons with almost any condition. In nearly all conditions that cause ambiguous genitalia at birth, self-initiated gender change has happened in both directions.

Reliable statistics about gender change in the intersexed are not available. This is in part because of biases in what types of cases tend to be published in the medical literature. When an intersex person repudiates his or her sex-of-rearing, it may not reflect well on the medical profession in general or on the particular caregivers who advised the original choice of sex-of-rearing. This is one reason why some such cases are absent from the medical literature and why, in general, the medical literature on intersex gender transition is sparse.

Physician attitudes and practices regarding initial sex-of-rearing are controversial and have changed several times during the 20th century, and this in turn has had biasing effects on the direction of change in intersex persons who feel that their initial assignment was inappropriate.

Motivation

Intersex transitioners report a very wide variety of motivations to change gender. Some make statements very similar to those made by non-intersexed transsexuals, while others report motivations such as anatomical suitability that do not exist for non-intersexed transsexuals. Some may have more than one reason to transition. Note that some persons are reticent about issues relating to gender and sexuality and/or may have difficulty articulating their feelings. Some may report feelings of belonging to the other gender while other may report that subjective feelings of gender are not a large part of their motivation.

Reasons for transition may include:

• Difficulty "passing" in the original gender due to virilization in a person initially assigned as a girl or lack of virilization in a person initially assigned as a boy.

• A subjective feeling that they desire to, or feel that it would be more appropriate to, live in the other gender.

• Belief that they are more suited anatomically or physiologically to the other gender. This could include appearance, ability to have heterosexual intercourse or fertility.

• Belief that they are more suited by emotional temperament to the other gender. This could include sexual orientation.

Counselors should realize that not every person adapts to his or her life circumstances in the same way and that different motivations for gender transition may be legitimate for different persons. The goal is for a person to be able to live a happy and successful life, not to conform to theories and stereotypes about gender.

Counseling and Support

Peer-group support resources created for either the intersexed or transsexuals may be helpful for intersexed transitioners but not completely suitable.

Intersex persons seeking to change their gender may have had irreversible treatments in conformity with their originally assigned gender which are regrettable in light of their target gender, and this may be a great source of emotional distress.  These treatments (surgical and otherwise), intended to support them in their originally assigned gender, have very often been made available on demand or even imposed involuntarily. Counseling to provide full information about treatment options and to suggest alternatives is seldom provided, (even when counseling solely for emotional support is provided). In marked contrast, treatments to support a chosen gender other than the initially assigned one may be withheld or deferred, with conditions such as lengthy periods of counseling imposed.

Patients and caregivers may come into conflict regarding the appropriateness of the proposed change.

Protocols such as the WPATH (formerly HBIGDA) standards of care for treatment of gender identity disorder may not be completely applicable and should not be followed rigidly. The "real life test" - a trial period of living in the target gender before irreversible treatments - is usually an appropriate and worthwhile precaution if treated as a step in an overall plan, but may be resented as a punitively imposed purgatory by persons who feel they have been the victims of poor decisions made by others while they were children.


False Claims of being Intersex

Some persons, for reasons which probably vary, claim to be intersex and to have changed, or are changing, their sex-of-living. It is not always possible to distinguish such persons from genuine intersex transitioners. One can only speculate about such persons' motivation but it is very likely that at least some of them are seeking to escape the externally imposed stigma of being a transsexual, or in some cases, internalized feelings of shame and stigmatization. Others may identify as intersex subjectively or psychologically but without having an actual physical intersex condition.

The activities of such persons tend to be detrimental to the interests of genuine intersex transitioners by, if they are convincing, spreading misinformation and, if they are not convincing, creating a hostile environment of suspicion and skepticism.

The era of internet communication has greatly improved opportunities for peer group contact and support among sexual minorities but it has also made it easier to create a false public persona while concealing one's personal characteristics and even one's identity. It is more difficult to conceal one's actual identity though communication media such as postal mail, telephone and especially, a personal meeting.

One person who claimed, falsely but somewhat successfully, to have been an intersexed person inappropriately assigned at birth was the late writer Dawn Langley Simmons (born Gordon Langley Hall). In several autobiographical books and in at least one televised interview (on Tom Snyder's The Tomorrow Show) Simmons claimed to have been born with ambiguous genitalia but a uterus and ovaries internally and, after surgical feminization, to have given birth to a daughter. This is actually plausible medically but in Simmons's case was a fabrication.

In his book Peninsula of Lies, journalist Edward Ball describes how he tracked down various persons, including a gay man who had been Simmons's (Hall's) sex partner before transition and Milton Edgerton M.D., who had performed Simmons's (Hall's) sex reassignement surgery at Johns Hopkins Hospital in 1968, both of whom stated that Hall had had normal male genitalia. Ball also spoke with Simmons's husband who said that her claimed daughter had been born to a local (Charleston, SC) woman, although fathered by him.

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References

Ball, E. (2004).     Peninsula of lies : a true story of mysterious birth and taboo love.  New York : Simon & Schuster.

Houk CP, Dayner J, Lee PA. Genital ambiguity with a Y chromosome: Does gender assignment matter?.  J Pediatr Endocrinol Metab. 2004;17:825–839.

Mazur T . Gender Dysphoria and Gender Change in Androgen Insensitivity or Micropenis. Archives of Sexual Behavior. 1999 ; 10: 1-69.

Meyer-Bahlburg, H. Gender Dysphoria and Gender Change in Androgen Insensitivity or Micropenis. Archives of Sexual Behavior.  2005 August. 34(4) ; 371-373.

Money, J. & Ehrhardt, A. A. (1972). Man and woman, boy and girl." The differentiation and dimorphism of gender identity from conception to maturity. Baltimore: The Johns Hopkins University Press.

Money, J. (1991). Biographies of Gender and Hermaphroditism in Paired Comparisons. Amsterdam: Elsevier.

Money, J. (1998). Sin, science and the sex police. Essays on sexology and sexosophy. Buffalo: Prometheus Books.

Reiner WG . Gender Identity and Sex-of-rearing in Children with Disorders of Sexual Differentiation. J Pediatr Endocrinol Metab. 2005 June; 18(6): 549–553.

Zucker KJ . Intersexuality and Gender Indentity Differentiation. Annual Review of Sex Research. 1999 ; 10: 1-69.