Trump and the Ambiguities of Science and Sex

Trump wants to redefine gender, but science teaches us otherwise

Posted Oct 28, 2018

When a child is born, the first words I’ve usually heard uttered in delivery rooms are “it’s a boy” or “it’s a girl.”  But, in fact, sex is not always easy to determine.

In medical school, the oddest lecture I ever attended was on ambiguous genitalia.  The professor, a bald elderly man with a round face, wore a long white coat and showed us scores of photographs of infants whose genitalia were neither completely male or female, but instead took a wide range of forms in between.  Various bulges and foldings seemed too small or not fully formed.  The reasons for these biological variations were numerous – from genes to hormones and enzymes. 

It was 1983.  Most of us in the class were in our early 20s.   The presentation riveted us, but many of us shifted in our seats, uncomfortably, never having seen or imagined such odd anatomy.  A few students tittered.  The lecture was one of the only ones we received related to sex or sexuality, and the only one of these talks not exclusively about heterosexual reproduction.

I have recently been thinking about this talk since the Trump administration wants to define gender “narrowly” as “a biological, immutable condition determined by genitalia at birth,” using a “clear,” “biological basis…grounded in science, objective and administrable,” with any disputes resolved through genetic testing. 

Yet, science teaches us that sex is in fact not binary.

Usually, the cells in our bodies contain 46 chromosomes – tightly bundled coils of DNA – 23 from each of our parents.  Some of these cells, so-called germ cells, divide to create eggs and sperm, each with 23 chromosomes, but sometimes these processes go awry.  Ordinarily, when a woman’s egg and a man’s sperm merge, a single cell embryo results with 46 chromosomes, which this cell then copies.  Tiny protein threads, called spindle fibers, then latch onto each chromosome and pull these into a neat row, and the cell splits, creating two daughter cells that each take an equal amount of DNA.   These two new cells subsequently halve, generating four cells that in turn cleave to produce eight cells. This mass of cells continues doubling until, eventually, a fetus and later a human being result.

But for almost 1 million Americans, these processes occur differently.  Cells end up with too few or too many chromosomes.

Two of the 46 chromosomes are so-called “sex” chromosomes – labeled by scientists as X or Y.  Most females have two X chromosomes, and males have one X and one Y chromosome

Yet one in 400 people, or a total of 822,000 Americans, have other genes.  Over 320,000 Americans are born not with two sex chromosomes, but with three – XXY, XXX, XYY.  Other people possess only a single such chromosome – X or Y.  Some people have four – XXXX.  Environmental toxins are increasing the frequency of such variations.

In other people, various endocrine or enzyme deficiencies lead correct numbers of chromosomes to express themselves incorrectly, creating ambiguous genitalia that, in all, about 1% of infants have.  Just as the colors of the sky at sun-up and sun-down are not just blue and black, but rather a wide spectrum of yellows, oranges and reds, so, too, biologically, sex is not dichotomous.  Genetic tests reveal many in-between states.

Historically, efforts to force individuals with ambiguous genitalia into one of only two rigid roles have failed.  Most notorious was the so-called “John/Joan” case.  In 1965, David Reimer was born male, but after a botched circumcision as an infant, surgeons inadvertently destroyed his penis and decided to give him female genitalia instead.  John Money, a leading psychologist at Johns Hopkins, and others supported this decision, arguing that gender identity resulted from nurture alone, not nature, and was merely a social construct, with no biological basis.

David was raised as Brenda, but around the age of 9 and 11, felt he was male.  He encountered increasing difficulties, and eventually wed a woman, but had marital problems.  Though the doctors declared that they had successfully changed his gender and sex, he ended up killing himself.

This sad case reminds us how much our genitals alone do not determine who we are.  Sex and gender identity reflect varying biological processes that we don’t fully understand. 

Transgender individuals know these complexities well – that gender identity is not shaped by genitalia alone, but lies beyond our control. 

Luckily, since the early 1980s, social attitudes have begun to change.  Every year, these scientific facts reassure tens of thousands of parents of infants born with abnormal numbers of genes or types of genitalia.  These parents and their families come to recognize this complex biology and not blame parents for these anatomical variations.

But as a society, we still have a long way to go.  Today, medical school classes teach more about sex and sexuality, though still not enough.  Yet the biological bases of sex and their complexities are vital for all of us, not just medical students, to grasp.  The more we appreciate the science, the better off all of us – not just transgender individuals – will be.