Of every 1,000 births 1.7 are intersexual which means that in a population of 2,000,000 people about 3,400 of them have aspects of both genders. Nicky Phillips (left), with help from transsexual partner, Leslie Stephens, finally accepted her intersexual identity. Fiona Garden photo.

By Colin Thomas
Publish Date: 28-Jul-2005

Nicky Phillips and Leslie Stephens are a friendly, older lesbian couple who live in Richmond with their dog, Mahoney. Nicky had an unremarkable girlhood. Then, in her 20s, she discovered that she is chromosomally male.

Kelly (not his real name) makes his home in a small town in the Kootenays. He is XX, which makes him chromosomally female, but he was born with a mix of sexual characteristics, including a large clitoris and what he describes as testicles. (They may actually have been ovarian tissue.) Most people perceive him as a man, so he accepts male pronouns, even though he feels that he is a combination of both male and female. Kelly was once deeply aligned with lesbian separatists. His journey from that position to public manhood is reminiscent of the cartoon character Pogo, who went on a wartime scouting mission and returned with the news: "I have seen the enemy and it is us."

For his part, Aaron, who asked that only his first name be used, arrived in the world with standard female chromosomes and organs. He identifies as a transsexual guy and has been taking testosterone for three months. He will have chest surgery to remove his breasts, and he may or may not have a hysterectomy, but will probably not have the genital surgery that could give him a penis. "I really like the thought of keeping my genitals with the way that T [testosterone] is shaping them," he says. "If there was a tranny pronoun, I'd use it. I like the fact that my body is just different. It's hot."

Many people react to anomalous experiences of maleness and femaleness with shock and derision. Intersexual (hermaphroditic) people are "freaks," and transsexuals are "neurotic" and "sick" even, according to some fundamentalist feminists, "reactionary." As Milton Diamond, who is a professor of anatomy and reproductive biology at the University of Hawaii, puts it: "Nature loves variety. Society hates it."

But it's probably in our best interests to embrace sexual variation. After all, who feels totally comfortable in their gender role? From brutalized women to demonized men, who doesn't bear wounds from the war between the sexes? That war is based on the assumption that the opposing armies are easily identifiable. What would happen if our cherished armour of maleness and femaleness started to disintegrate? From the sissy boy who learns to be ashamed to the straight guy who can't open his heart when he's having sex, from the teenage girl who acts dumb to get dates to the adult woman who gets stuck in rage against men, surely we'd all be better off.

Life isn't necessarily easy for transsexuals and intersexuals, "many trans people regard surgery as the only alternative to suicide," but as more gender-variant folks realize their unique potentials they are pointing toward greater spaciousness in the experience of gender for all of us.

For the record: many transsexuals and intersexuals do not regard themselves as gender-variant. All sorts of folks in both camps happily define themselves as simply male or female. I respect those choices, but this article is not about the people who have made them. This piece is about emerging variations and possibilities that reach beyond the binary system.

Some of the terrain that the variant inhabit is still dangerous, but in occupying it they are creating a kind of demilitarized zone, a promised land, a hint of the common ground of fantastic possibility.

Nowhere is our cultural anxiety about gender differentiation clearer than in our treatment of intersexual infants. Some surgeries on nonstandard genitalia are required, to avoid urinary infections for instance, but for decades it was common practice to perform medically superfluous genital surgeries on intersexual infants to get them to fit into one camp or the other.

Kelly is 34. Just eight years ago, his dad revealed his diagnosis to him; medical information has commonly been withheld from intersexual persons. Kelly has congenital adrenal hyperplasia (CAH), which is the most prevalent form of intersexuality. In XX (chromosomally female) children, CAH can cause mild to pronounced masculinization of the genitals at birth or later; Kelly is far to the masculinized end of the spectrum, but that he has a big clitoris is typical.

Until the '60s, it was standard practice for doctors to perform complete clitorectomies if they considered an XX baby's clitoris too large. Today, clitoral reduction is the most common surgery. In that procedure, a portion of the clitoral shaft is removed, then the glans is reattached to the stump. Not surprisingly, reports from adults who underwent clitoral surgery as children make it clear that it has a detrimental effect on sexual function, particularly on the ability to attain orgasm. Thousands of XX CAH babies have been operated on; Kelly escaped, thanks to his parents' intervention. He remembers being angry with his father for allowing surgeons to remove what he was told were testicles. "I was like, 'Why the fuck did you let them do any of that?' and he said, 'Well, we didn't let them touch your dick [clitoris].' It was like, 'You're right, Dad. Thank you.' I can't imagine."

Until the '80s in North America, if an XY (chromosomally male) baby's penis was shorter than 2.5 centimetres (one inch) stretched, that child was routinely reassigned as female. This involved castration and, later, the construction of a vagina.

Fortunately, activists such as Cheryl Chase, one of the earliest and most vocal members of the Intersex Society of North America (ISNA), have worked hard to put an end to such procedures.

One of the underlying assumptions of routine sex-reassignment was the notion that environmental influences are so much more important than biological factors in determining sexual identity that, with the right kinds of intervention, virtually any child can be raised successfully as either sex. Recent studies of the brain indicate that sexual identity is hard-wired, at least to some degree. As Daniel Metzger, a pediatric endocrinologist at British Columbia's Children's Hospital, puts it: "More and more we recognize the role that the baby's brain may play."

Doctors these days are much less likely to perform such medically unnecessary surgeries. "Sex reversals [in infants] are way, way less commonly done than they were in the '80s," Metzger says. Doctors at Children's recommend that parents of male babies with small penises avoid surgery; testosterone may help the organ to grow. They also advise against early clitoral reductions. Some families still insist on them, however. Asked how many are done, Metzger replies: "I'm guessing it's at the most one girl a year in this province."

That's an improvement over previous practice, unless you're the child whose clitoris is altered. "I think it's absolutely horrible that anything is happening to people before they can choose," Kelly says. "It's completely ridiculous. Obviously."

Metzger, who speaks respectfully of the activist Chase, says that, besides discouraging early surgery, the doctors at Children's offer counselling support for families. As ISNA suggests, Metzger and the team he works with encourage parents to raise their child as the sex it's most likely to identify with and accept the possibility that their maturing offspring could make a different choice that might involve consensual surgery.

Kelly has covered some interesting territory in coming to terms with his unusual body. "I found a pretty decent community with the lesbian separatists," he says, recalling a time when he identified as female. "It's very odd [in those circles] because you can act as much like a man as you want and you can look as much like a man as you want as long as you say, 'I am a woman.' Then you're totally acceptable. At some point, I started to realize how ridiculous that was. Then the whole trans community started coming out and the lesbians were very anti that. I felt like, 'You know what? I have more in common with those people.'"

Obviously, many lesbians are supportive of transsexual and intersexual folk, but some extremists are not. In her 1979 book The Transsexual Empire, Janice Raymond wrote: "All transsexuals rape women's bodies by reducing the real female to an artifact, appropriating this body for themselves. However, the transsexually constructed lesbian feminist violates women's sexuality and spirit as well."

Kelly has found a new sanctuary. Although the Kootenay town he lives in has a population of just a few thousand, he says that it's the first place he has felt safe living as a relatively out intersexual person. One of the advantages of being in such a tightly knit community, he says, is that anyone who might want to pursue him romantically already knows his whole story. "I think my preference is probably for male partners," he adds, "but I've had a lot more female partners because that's who tends to be interested in me. Most of the men I'm interested in are fags, but fags tend to be really interested in dicks and tend not to be able to get around the fact that I don't have one."

Kelly enjoys the support of a group called Gender Outlaws, which gets together once a week in Nelson.

Nicky's story is a variation on the theme of self-acceptance; she speaks freely about the emotional aspects of coming to terms with her intersexuality.

Nicky was born with an intersexual condition called androgen insensitivity syndrome. That means that she has both X and Y chromosomes, the standard male combo. Nicky also had testicles, which were descended at birth, but which doctors diagnosed as a double hernia and placed in her abdomen. Surgeons later removed them because testes pose a significant cancer risk to AIS women.

While she had them, Nicky's testes produced plenty of testosterone, but her cells were incapable of responding to it so very little masculinization took place. She was born with a vagina and grew up as a girl. When she hit puberty and her testicles started producing estrogen, as all testes do, her breasts ripened, her hips widened, and her waist narrowed.

The bodies of people with AIS cover a wide spectrum: most are quite feminine, but some people with AIS identify as male; Nicky is far to the feminized side of the scale.

Long before her AIS was diagnosed, Nicky experienced many of its classic symptoms: she didn't menstruate; her vagina was shallow; her doctor even informed her that she didn't have a uterus. She found that last news crushing, and she remembers that another oddity, the failure of her body to produce pubic and underarm hair, engendered intense feelings of shame. Still, no one diagnosed Nicky's condition until she was 25 and investigating surgical options for vaginal reconstruction. Blood tests revealed her chromosomal maleness.

Sitting in her seaside Richmond condo, the retired social worker recalls, "You do have a moment where you go, 'Wait a minute. Am I male? Am I female? How do people see me?' At that point, I could intellectualize gender, but I was really in trouble with coping with gender as a continuum, which is how I see it now. It was like, 'You're one or the other, so which box [M or F] should I be filling in?' There was really nowhere to be."

Four years after her diagnosis, Nicky spent three months at Cold Mountain, a therapeutic community on Cortes Island. (The facility is now called Hollyhock.) She says the tears she shed there were about "trying to own the body that I was given. Trying to come to terms with whether or not I was acceptable, whether or not I'd be an acceptable partner to somebody."

Nicky has lived with Leslie for almost 11 years and they have been married for close to two. Nicky credits Leslie as being the single greatest influence in helping her to feel comfortable with her intersexuality. It was Leslie who directed Nicky to the ISNA Web site and Leslie who encouraged Nicky to go public on Rafe Mair's radio talk show.

Hanging out with gender-variant people can quickly dislodge one's concepts of what it means to be male or female, gay or straight. Leslie, who was once a petty officer in the U.S. navy, is transsexual. Nicky points out that because she and Leslie both have X and Y chromosomes, they are a gay male couple by one definition. Nicky grew up as a female and Leslie as a male, which would make them heterosexual. But they choose to identify as lesbians because that fits their experience.

Nicky and Leslie share a wicked sense of humour. When Nicky e-mailed me a picture of Mahoney, their beagle-lab cross, she attached a note that referred to this article: "Leslie and I thought you might want to run a picture of the three of us with the caption, 'Which of these is a male with no balls? Answer: All three.'"

Although Nicky was once anxious about her femininity, that agitation has waned: "The older I've gotten, the less that's been a problem. What I've found interesting is sometimes I think, 'I wonder what kind of man I would have been if I'd gotten the X gene that didn't have this insensitivity?'"

Nicky is the West Coast contact for the AIS Support Group of Canada and welcomes phone calls from anyone with AIS or other intersexual conditions.

If you're a non-gender-variant reader, you may be starting to wonder what all of this has to do with you. Well, intersexual births can be embraced as reminders of commonality. Every fetus begins with the potential to be male, female, or a combination of both. In the standard course of development, mullerian or wolffian ducts, which lay the groundwork for female and male reproductive systems, either flourish or whither depending on exposure to different levels of certain sex hormones. The differences in those levels are minute, parts per trillion or parts per billion. The fetus's phallus will either become a penis or a clitoris. The gonadal mound will either become labia or a scrotal sac. Viewed from this angle, sexual differences don't seem so huge. The "gender divide" ain't so wide.

It's also worth noting that intersexuality, which results from developmental variations, is more common than was once thought. The most reliable estimate is that intersexual babies account for approximately 1.7 of every 1,000 births. That means that in the Greater Vancouver Regional District, which has a population of about 2,130,000, perhaps 3,620 of us are intersexual.

Although intersexuality helps to make the argument that the differences between the sexes are slight, transsexual experience bears witness to the fact that they can still be tremendously important. Some theorists who view sex roles entirely as social constructions accuse transsexuals of essentializing maleness and femaleness. It seems fairer to say that they are responding to a deep personal need that requires action of a radically transgressive nature.

The research is still scant, and some people find the inquiry itself offensive, but there is a tantalizing possibility that the sexual identities of transsexual people have their origins in the brain.

Men and women have different numbers of neurons in an area of the brain called the BSTc. Robert Sapolsky, a neuroendocrinologist at Stanford University, reports that both preoperative and postoperative transsexuals have the amount of BSTc neurons that is typical of the sex they believe themselves to be. Studies that have looked elsewhere for causality, in sexual trauma, faulty parenting, and so on, have come up blank.

The four transsexual people I talked to are all bravely redefining maleness and femaleness. Thanks to hormone treatments and implants, 24-year-old Bobbi (a pseudonym), who is a male-to-female transsexual, has breasts, but she doesn't know if she'll get vaginoplasty. She enjoys sex and fears the possible loss of sexual function.

Besides, for Bobbi, transitioning is a mysterious process that doesn't come with a predictable end point. She speaks of an MTF friend who has had the full array of surgeries and electrolysis: "Now she's just done. I wrestle with that a bit. Maybe the first book I ever read [about transsexual experience] was Kate Bornstein's, Gender Outlaw. In it, she says: 'Having come through all of this, I still don't know what's going on.' I'm much more able to identify with that than with the concept of going from point A to point B. I am constantly changing my definition of myself."

The creation of new gender space is something the posse of female-to-male trans men I talked to endorses heartily. They're all around 30 and live together near Commercial Drive. Duncan is a muscular, foxlike guy. Fin is darkly handsome; black stubble pokes through the skin on his suntanned cheeks. And Aaron, who has just started testosterone, is enthusiastically boyish.

"Your voice gets deeper," Aaron says with a grin. "Your genitals change shape pretty quickly. You're turned on constantly, constantly turned on." Having been socialized as a woman, though, he knows enough not to give his urges selfish expression: "I would never act like those guys I dated when I was 16. I would never treat my girlfriend like that, demanding, because I know what that feels like."

Many FTM men take the position that they have always been male and that surgery has allowed their bodies to catch up with reality. While respecting that view, these guys assume a different stance. "I identify as a trans person," Fin explains. "I'm male, but I'm not suddenly this bio-dude. I'm not going to live my life as though I've always been a man. I've lived most of my life as a female and I'm not going to ignore that; it's my past."

Some women resent trans men for the privilege they think that FTMs gain in the change. These guys say that, in reality, their lives have become more restricted in some ways. "People view me like a dude," Fin explains, "and I get treated totally differently. I can't still be the riot grrrl that I was; I have to watch my mouth now or I'm going to get decked."

These three pals may make different decisions about what shapes their bodies will take. Fin is the only one who definitely wants a dick. "When I was about six I had this recurring dream that the penis fairy would fly in through the window one night," he reveals. "She would flutter over my bed and wave her magic wand and I would grow a little penis." Within his dream, he would wake up and dance on his bed, yelling, like the puppet child in Pinocchio, "I'm a real boy! I'm a real boy!"

Of the surgical options, he is most likely to choose metoidioplasty, in which the clitoris is released from its hood. The urethra is extended with the labia minora to end at its tip and the labia majora can be shaped into a scrotal sac. Referring to his vagina, Fin says with a smile, "I do plan on keeping my tranny bonus hole. That's staying."

All of this opens up a huge range of personal and interpersonal potential. Referring to both sex and sexual identity, Duncan says: "I find the whole thing so much more colourful now." Aaron agrees: "The thing I find most exciting when I start to date someone is trying to figure out how our genders fit together."

For many years, our culture has viewed gender in terms of binary organization. The experience of intersexual and transsexual people releases us into a sphere of fluid possibilities. Maybe now we can all admit that we're a lot more complicated than we've been letting on. On some level, at least, haven't most of us been shamed for picking up the wrong toy?

RESOURCES: Intersex Society of North America, www.isna.org; Canadian AIS support group, www.medhelp.org/www/ais/, local contact Nicky Phillips, lesnick@shaw.ca, 604-274-9630; B.C.'s Children's Hospital, www.cw.bc.ca/endodiab/endolink.asp#sex; Gender Outlaws (Nelson), 250-354-5362; Transgender Health Program at the Three Bridges Community Health Centre, 301-1290 Hornby Street, 604-734-1514 or 1-866-999-1514 (toll-free in B.C.), transhealth@vch.ca, www.vch.ca/transhealth