EDIT: I added two paragraphs on the politics of sex determination that I meant to discuss in the original post.
The conversation on “gender as determined sex.”
Our experience of gender begins, whether we’re conscious of it or not, at birth. When the doctor pulls us from the womb, she looks at our genitals and makes an evaluation – does the child look male or female? This evaluation isn’t as straightforward as it may seem. When the doctor looks between the child’s legs, the only thing she sees is the apparent genital morphology. She can’t see the child’s chromosomes, test the child’s gonadal tissue, or perfectly predict the child’s hormonal trajectory. All she sees is whether the child’s genitals look phallic or yonic, and from that she makes a broad biological assumption. This assumption is the child’s assigned sex.
For intersex persons with ambiguous genitalia, this process of assigning a sex is thwarted because their genitals don’t read one way or the other. In a more rigorous medical atmosphere, the doctors will then do hormonal and genetic tests to check on the person’s other sexed characteristics. If they find, for example, that the person has xy chromosomes, they may assign that person a male sex even though their genitals are undetermined. This is what I call determined sex, the biological pronouncement made once doctors do a thorough evaluation of chromosomes and hormones as well as genitals.
Problems arise when the doctors can’t determine one single dominant sex. What if the chromosomes are mixed as well? Often times, in this situation doctors will surgically assign a sex (what we might call constructed sex), and then assign a gender.
Assigned gender is the verbal pronouncement the doctor makes after she reads the child as male or female. She pronounces it “a boy” or “a girl.” From assuming the child’s sex, she then foretells – usually correctly, but sometimes incorrectly – that child’s entire gender destiny. This pronouncement most immediately determines the child’s legal sex, the little M or F that appears on their birth certificate, which will determine their legal status in all walks of life.
For intersex people, their site of embattlement includes all the above. The doctors aren’t certain about how their sex characteristics add up, so they not only guess at the person’s sex, but also guess at the person’s gender. If a person has both xy chromosomes and a vagina, the doctors are assuming what this mix means. Is the person a single sexed thing – male or female? And can we know from their biology how they will embody those sexed characteristics – as a boy or a girl? In this case, the facts of sex are clearly in question, which throws the world of gender into question as well.
[EDIT] Determined sex is largely a medical issue, although brushing it under the rug as “something for the doctors to figure out” overlooks the gender politics that overshadow intersex issues. When a doctor decides the sex of a physiologically “ambiguous” child, he never achieves complete objectivity on the issue. To choose the child’s sex, he first has to choose a theory of gender: often either based on genetics (the person is male because they have xy chromosomes), predominance (the person is female because most of their sex characteristics appear female), or convenience (the person will be made female because it’s easier to surgically create a vagina).
The underlying problem is the social pressure to immediately determine the child’s sex and “normalize” it. When a child is born sexually ambiguous, doctors, parents, and clergy often freak out and treat it as a medical emergency. This forces the medical team to make brazen decisions which often leave the child scarred from haphazard invasive surgery. When the child’s sex is undetermined, in many cases the doctors’ guess is as good as anyone’s as to whether they will grow up to be a boy or girl, and so any choice that’s made on behalf of the child is essentially Russian roulette (see the discussion in Part 3 on David Reimer). This is why many intersex activists advocate forgoing surgical interventions until the child is old enough to both know their gender identity and make an informed decision.
To a limited degree these problems also apply to transsexuals. There is the biological possibility that transsexuals have a brain that is physiologically sexed as the gender they identify as. This is what I call brain sex. So we can talk tentatively about transsexuality as an intersex condition (what I call being transsexed), in which case assigned and determined sex are thrown into question. If I have a “female” brain and male genitals, why should the doctors assume that my genital sex trumps my brain sex? I think these are valid questions, although I don’t think they’re the primary site of embattlement for transsexuals. I talk about this more in the next section.