New York State issued the nation’s first intersex birth certificate last week. NBC News reported on it here. I encourage you to read the report on 55-year-old Sara Kelly Keenan who got the state to change the sex on the birth certificate to the non-binary term.
Intersex is a current term used to refer to the mercifully rare condition of being born with a truly ambiguous body sex, where the body does not match the chromosomes. It can be a chromosomal, gonadal, or genital abnormality. Although the article does not give details, Keenan most probably has what is called Androgen Insensitivity Syndrome, a condition occurring in 1 to 3 of every 50,000 births, where a hormone imbalance results in a body with male XY chromosomes but external female genitalia at birth.
The article celebrates Keenan’s new privilege to identify as intersex, rather than male or female, on legal documents. But there are three questions that NBC raises without addressing:
1. Are the very few speaking for the vast many? We should ask how many intersexed-born people do NOT view their condition as a good thing. We will not hear from those who do not want to be the next poster-child for the LGBT movement. What those other folks want is to have the corrective operations and treatments (which are now widely available) quietly done and to get on with their lives. Or they are immensely grateful to their parents for having the operations done when they were babies. They don’t talk to news outlets and don’t make YouTube videos. Keenan told NBC Out, “Not all intersex people will choose to identify legally as intersex.” That “not all” may really mean “practically all.”
One might argue that the sad intersexed think that their condition is bad because society’s outdated categories have messed them up. But they could just as well think what they think because they believe that gender is real. In any event, these folks are not being consulted in this celebration. Have you ever seen NBC do a story on the intersexed who consider their condition a birth defect? Don’t hold your breath.
2. Do rare aberrations prove what Keenan’s lawyer calls, “the myth of the [gender] binary”? Advocates seem to think that the very existence of an abnormality, however rare, shows that there is no meaning to a male-female division of humanity. But when a rare baby is born with one leg, do we question the normalcy, more than that, the health, of having two legs? Do we rush to define a new category of locomotion (say, hoppers?) instead of giving the poor child a prosthetic? There are volumes of medical studies now documenting sex differences. Though most of these occur as overlapping distributions, the differences point to a real significance to the gender binary, as announced in Genesis 1:27.
3. What will our children grow up to say? Keenan generously proclaims, “not all parents will choose to have their intersex child identified as intersex on birth documents. But for those who do, the option must exist.” What lies beneath Keenan’s show of magnanimity is great tragedy. NBC is trying to convince readers that, as the author puts it, “A Third Gender Emerges.” Some parents may be persuaded by the state’s new category to opt for identifying their baby as an intersex child. Thinking that it must be the right thing to do, they will withhold treatment and so relegate their child to a life of hardship. Consider the estrangement between parents and children that is about to occur.
Maybe Sara Kelly Keenan, as an adult, should have whatever Sara Kelly Keenan wants on the passport the airport asks for or the driver’s license the policeman takes through the window. But please, let us have compassion on those with these rare birth afflictions and do not withhold the corrective surgeries that are available.
Would you want your parents deciding to preserve your birth conditions on the theory that gender does not exist?
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I notice that you are careful not to use a feminine pronoun for Sara Kelly Keenan. Is this because of Keenan’s decision to identify as intersex instead of male or female, or is this how you would refer to any woman with androgen insensitivity syndrome (AIS)?
Despite being XY, I think it’s fair to say that most individuals with AIS are assigned female at birth and continue to identify as women into adulthood. To me, this seems rational and biblical. Emily Quinn, an animator and YouTube celebrity, has AIS, and it would be illogical to refer to her as a male when she has externally looked like a normal female since birth. There’s nothing to “correct” about AIS other than removing the internal testes, which can become cancerous.
As for other intersex conditions, I agree with Denny Burk that it is best for parents to make an educated guess and raise the child as either male or female. I also agree with Burk (and the Intersex Society of North America) that corrective surgery should wait until the child is old enough to make an informed decision. There are too many tragic stories of intersex individuals who reject the surgical genders their parents assigned them at birth.
Dear Jay,
Thank you for your helpful thoughts on this. Yes, I did reserve judgment on S. K. Keenan’s pronoun because I really do not know the specifics of the situation.
And yes, I would agree that, in the case of complete Androgen Insensitivity (as Emily Quinn has), it is best to understand the person as a woman. That should happen, until there is a technology to correct the mutation of the AR gene and allow the body to develop in response to androgen. It is sad that these women are among those unable to bear children, but it is testimony to the glory of the human body that it can take the hormones from their internal testes and turn it into usable estrogen for them. God has built a lot of redundancy in the system to give a happy life.
The opposite track, though, should be taken with mild AIS (thankfully, even less common). That is, I would think that they should be raised as guys, though again, sadly, unable to sire children.
These cases are pretty clear. No, the real difficulty comes with partial AIS, where hard decisions have to be made, and perhaps, as you say, postponed. Again, mercifully occurring, I believe, at the same or less precedence of complete AIS (0.002% to 0.005% of male (XY) births), partial AIS is a condition needing sensitivity, understanding, and prayer.