beyond the binary. SEX AS A SPECTRUM A zine by Nghiem Nguyen
Made in 2019
Table of Contents
Introduction Chapter 1: Biological determinants of sex/gender: a spectrum Chapter 2: Ethics: impacts of the medical community Chapter 3: Non-binary identities in indigenous cultures Chapter 4: Resources and support Chapter 5: Moving forward: dismantling the binary Closing Note
introduction
Hello! My name is Nghiem Nguyen. I identify as a queer, nonbinary, Vietnamese-American who is also a first-generation low-income college student. I use She/Her or They/Them pronouns. I am a Biology major and Asian American studies minor at Pomona College, CA. I decided to create this zine in order to raise awareness and expand upon how the majority of society currently understands sex and gender. While some claim that official Biological Science™ gives evidence that there are only two sexes or two genders, I am here to say that this is wrong. Basically, I want to highlight the fact that both sex and gender exist on a spectrum. Even in Biology, there are so many ways to understand one’s sex. Throughout this zine, I want to center the experiences of intersex folks because I often feel that they get overlooked within the LGBTQIA+ community. Last but not least, I also want to acknowledge that I, myself, do not identify as intersex. I do not personally know and will likely never know the experiences that intersex folks go through. However, I want to use this zine to uplift their voices within the community and hopefully spread more awareness about the dangers of biological essentialism. As someone from the queer/trans community and an aspiring medical provider, it is extremely important that I can be an ally to the most marginalized identities in my community.
who are intersex folks?
Intersex flag
According to Intersex Human Rights Australia (IHRA), Intersex individuals are born with physical sex characteristics that don’t fit the binary medical norms for female or male bodies. There are many different kinds of bodies and life experiences. Intersex people can look typically male, typically, female, or androgynous. Intersex people can also identify in a variety of ways, including as men, women, intersex men, intersex women, intersex persons, non-binary intersex persons, etc.
image from pridelife.org
According to United Nations Free and Equal, 0.05% to 1.7% of the population is born with intersex traits, which means that being intersex is as common as having red hair. The belief that intersex folks are an extremely small percentage of the population is often used to dismiss their need for legal rights and protections. Intersex children and adults are often stigmatized and subjected to multiple human rights violations.
2% of the world population or about 150 million people or the same amount of genetic redheads or greater than the population of Russia
Chapter 1
Biological determinants of sex/gender: a spectrum
Sex, gender, and sexuality are all distinct categories, although often related. Each exists on its own spectrum, which may shift throughout one’s lifetime. (Even the model of a sliding scale is flawed. For example, more masculinity doesn't necessarily mean less femininity)
In general, people think of sex as something biological or physical about one’s body. For example, having XX or XY chromosomes, having ovaries or testes, or a vagina or a penis. For many intersex folks, however, there may be a combination of these various traits, a complete absence, something slightly different, etc. Think of the graph below as a visual representation of all the things that determine one's sex. Yet, in dominant science and medicine, we choose to sort them into two bins instead. This causes some people to inevitably be left out.
images from trueliberalnexus.wordpress.com
In general people think of gender as the psychosocial characteristics, behaviors, and forms of expression, that have been developed and influenced by society’s expectations. For example, expectations of masculine or feminine clothing, gender roles, speech patterns, hairstyles, etc. Despite these distinctions, it is important to recognize that the notions of sex and gender often overlap in both scientific literature and common language.
Many people believe that intersex individuals are people who have ambiguous genitalia or atypical chromosomal patterns. However, there are an estimated 30 types of intersex traits. Examples of several variations in sex characteristics include chromosomes, gonads, sex hormones (hormone production and hormone response), genitals, secondary sex characteristics, etc. Many intersex traits also go undetected throughout an individual’s lifetime or emerge during sexual development later in life.
e
The next page shows an infographic made by Pitch Interactive and Amanda Montanez (taken from ScientificAmerican.com) depicting the complexity of sex determination...
With such clear and diverse scientific evidence of the intricate and complex nature of sex determination, how can we possibly still hold onto the belief that sex and gender exist solely on a binary system?
Under the Trump administration, there have been statements that gender must be determined “on a biological basis that is clear, grounded in science, objective and administrable”. According to NY Times, the Department of Health and Human Services defines sex as either male or female, unchangeable, and determined by the genitals that a person is born with. Any dispute about one’s sex would have to be clarified using genetic testing. These statements are not only harmful to transgender folks, but are also just plain wrong and woefully ignorant. They completely leave intersex folks out of the conversation. They falsely claim that biology as “objective” fact upholds a strict gender binary, when scientists have known for decades that this is not the case.
Disclaimer: Although intersex identity has historically been defined by biology, some people have discussed that “intersex” describes their gender identity as well as the sex characteristics they were born with. Thus, it is important to note than an entirely biological determinist view of “intersex” may not necessarily be inclusive or viable.
Social Norms Biology
Psychology
Culture
Things to be careful of... Some people, including medical professionals, describe intersex individuals as having a “disorder” or “abnormality”. However, the majority of intersex persons don’t actually have any medical issues. Referring to intersex individuals as having a disorder only perpetuates and incorrectly justifies the human rights violations that occur with coerced medical treatments.
It is important to use non-discriminatory and inclusive language. Avoid using words such as “hermaphrodite” or “disorder”, as these are often considered offensive to intersex folks. It is also extremely offensive to ask someone what genitals they have.
Be mindful of hurtful language!
Chapter 2
Ethics: impacts of the medical community
Suzanne Kessler, American social psychologist and author of Lessons from the Intersex, points out:
"The belief that gender consists of two exclusive types is maintained and perpetuated by the medical community in the face of incontrovertible physical evidence that this is not mandated by biology.�
The Phall-O-Meter by the Intersex Society of North America satirizes clinical assessments of appropriate clitoris and penis length at birth. It is based on work by Kessler.
A report from the Human Rights Watch indicates that most of the bias that exists toward intersex children lies with surgeons and medical professionals rather than parents.
Medical professionals have a responsibility to protect the physical integrity of intersex individuals and prevent discrimination.
Intersex children are commonly subjected to unnecessary surgical procedures and other medical treatments in order to make their bodies conform to binary norms. These procedures are often conducted without free and informed consent of the individual. Oftentimes, they are performed on children who have no decision-making power over their own bodies. Some procedures are pressured onto individuals by use of threats of health risk (e.g. doctors telling parents that their child’s testes are cancerous to justify removing them). However, there is often weak evidence and little discussion of alternate approaches.
“Many intersex adults exposed to such surgery as children emphasize the shame and stigma linked to attempts to erase their intersex traits, as well as significant physical and mental suffering, including as a result of extensive and painful scarring. Many also feel that they were forced into sex and gender categories that do not fit them.” - United Nations Free and Equal
“I had never had the chance to be told the truth, to be given the chance to decide for myself how my body feels to me. My body was owned by the surgeons before I had a chance to lay claim to it.” - Jonathan Leggette, an intersex activist based in Washington State
Intersex individuals are often at risk for discrimination and may be denied access to inclusive health services, education, public services, employment opportunities, and sports. There have been several cases of female intersex athletes who have been disqualified from competing on their team based on their intersex traits. Health care professionals also often lack the necessary training and understanding that is required for the health needs of intersex folks.
The medical and science community has a responsibility to learn about and understand intersex individuals and the experiences they go through. We must demand better science that is inclusive of everyone, especially those who are found beyond the “normative”. It’s not just about good science -- it’s about practicing humane and inclusive science. It’s about demanding justice for the most marginalized and invisibilized communities.
Some Positive Developments... In 2013, Australia adopted the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act – the first law to include intersex status as a stand-alone prohibited ground of discrimination. The Australian Senate has also carried out an official inquiry into the involuntary or coerced sterilization of intersex people. In September 2015, the United Nations met for the first time to discuss intersex rights. In 2015, Malta adopted the Gender Identity, Gender Expression and Sex Characteristics Act – the first law to prohibit surgery and treatment on the sex characteristics of minors without informed consent. It also prohibits discrimination on the basis of sex characteristics. On Oct. 1, 2015, a Maryland law allows transgender and intersex people to change the gender on their birth certificates without surgery. Ireland, Colombia, Argentina and Malta have implemented similar laws and regulations. In 2016, the Chilean Ministry of Health issued instructions to its national health sector to stop “normalizing” medical interventions on intersex infants and children. Unfortunately, another circular later that year superseded this decision.
Chapter 3
Non-binary identities in indigenous cultures
Probably one of the most important things that people need to realize is that the binary way of viewing sex and gender is actually a prominent product of Western imperialism. There may also not be such a clear distinction between biological "sex" and psychosocial "gender", as there is in Western societies.
There are multiple examples of indigenous cultures and societies that are inclusive of options beyond just man and woman. Many of these identities cannot be contextualized with a Western lens. Mainstream definitions or labels of sex and gender do not serve to describe identities that have existed long before the dominant understanding of the LGBTQ+ community. Therefore, attempts by Western anthropologists to describe indigenous “gender variant” or “third gender” people often lack cultural understanding and misrepresent these identities.
Here are only a handful of examples: Hijras: used in India, those who are considered neither men nor women in their sex and gender identity and are able to function as a third group Khawaja Sira: “third gender” community in Pakistan/South Asia, who have held a long history of alternate gender norms and sexuality Māhū ('in the middle'): to Native Hawaiians and Tahitians, third gender persons with traditional spiritual and social roles within the culture. In pre-colonial history, Māhū were particularly respected as teachers, usually of hula dance and chant. They performed the roles of goddesses in hula dances that took place in temples. Māhū were also valued as the keepers of cultural traditions, such as the passing down of genealogies. Traditionally parents would ask māhū to name their children. Nadle (previous berdache, as called by French colonizers, is now seen as inappropriate): used by Native American Navajos and Zunis, referring to those who have a special status and function as neither male nor female Two-spirit: established in 1990, modern umbrella term used by some indigenous folks in North America, two-spirit individuals often play important ceremonial roles
Two-spirit world map provided by pbs.org "On nearly every continent, and for all of recorded history, thriving cultures have recognized, revered, and integrated more than two genders." - pbs.org
“Many different cultures have for thousands of years allowed for more fluid ideas of gender outside of the Western binary of male and female. These communities have essentially been at the forefront of these conversations prior to colonialism, yet are left out of the global discourse on these relevant topics.”
Left: Avalokiteśvara (Tibetan)/ Guanyin (Chinese)/ Quan Âm bồ tát (Vietnamese) A Bodhisattva who embodies healing and compassion and is able to take on any form of both male and female. Often depicted as androgynous and believed by many to be without gender. image from photo.thuyetphaponline.com
“Hijras have a special place in the South Asian version of Islam. People used to believe that God gave them two genders, so they must be God’s special, chosen people. Hundreds of years ago, Hijras had a tremendous amount of respect. In the 1800s, the British outlawed sodomy and cross dressing, and brought with them a conservatism that can still be felt today.” - Qasim Iqbal, a prominent HIV/AIDS and sexual health activist in Pakistan
It is important not to conflate transgender individuals with nonbinary individuals, especially in certain indigenous cultures that do not operate on a gender binary. In some countries, third-gender or nonbinary individuals actually have systematically less access to resources and may face greater discrimination than transgender folks. “By conflating both groups as the same, it not only erases both a history and a culture of a third gender, but it also erases the differences and tensions between both groups.�
Photo of khawaja sira community by Hammad Ahmad Khan
To read the full article on the distinct experiences of transgender and khawaja sira individuals in South Asia: https://wearyourvoicemag.com/lgbtq-identities/trans-khawaja-sira
Erasure of indigenous nonbinary identities is often associated with a violent colonial history inflicted by Western powers. In our efforts to fight for justice and human rights for intersex folks in modern Western society, it is important to also decolonize our thoughts and understanding of where the gender binary predominantly comes from.
Chapter 4
Resources and support
(A few) Intersex Activist Organizations: interACT: founded in 2006, a nonprofit organization focused on ending harmful medical interventions on intersex children (interactadvocates.org) Intersex Campaign for Equality (formerly OII-USA) (US): non-governmental organization that advocates for the human rights of intersex people (intersexequality.com) AID-DSD Support Group: provides information and support to intersex youth, adults, and families (aisdsd.org)
The United Nations, World Health Organization, and Amnesty International have all encouraged the deferral of “corrective� surgeries until individuals are of consenting age. While there has been a lot of progress made in terms of advocacy work for human rights of intersex individuals, there is still a lot of work left to do. Medical procedures and treatments which may be considered human rights violations against intersex individuals are still going on today. In addition, intersex folks still need greater protection from discrimination, access to justice and reparations, access to information, and legal recognition.
"We Need to End Intersex Erasure in Queer Communities" article by Hans Lindahl from them.us https://www.them.us/story/intersex-allyship-101
Photo of Hans Lindahl taken by ER de Grey
“Intersex, trans, and queer communities could be each other’s best allies. We have so much in common, and so much to learn from one another. Gay, lesbian, and transgender identities have been historically pathologized as mental disorders by the healthcare industry. Intersex is pathologized as a physical disorder. We face two sides of the same coin. In the case of intersex and trans communities, medical gatekeepers have created a rift between us. Intersex children are subject to non-consensual “normalizing” of their sex traits, while consenting transgender adults have to fight tooth and nail to access gender-affirming procedures.”
Sean Saifa Wall
an intersex activist, collage artist and public health researcher based in Atlanta GA Sean was assigned female at birth due to “abnormally” small phallus and undescended testes. He was also born with partial androgen insensitivity syndrome (when an individual is born with XY chromosomes but is resistant to male hormones). At age 13, Sean’s healthy undescended testes were removed because his mother was told by doctors that his testes were cancerous. The doctors also wanted to perform a surgery to create a vagina, but his mother said no despite ongoing pressure to “normalize” his body. Sean lived more than two decades as a woman before deciding to live life the way he always wanted to, as a man. As an activist, Sean has appeared on Huffington Post, ABC News Nightline, NBC Out and other media outlets. He is the former board president of InterAct, an intersex youth advocacy organization and is now an advisor for the Astraea Intersex Fund for Human Rights.
Watch his tedtalk: https://www.youtube.com/watch?v=9mvNmRlpfaM Other intersex activism work: https://www.unbornson.com/intersex
Emily Quinn
describes herself as "a ballsy intersex activist who uses humor and storytelling to create a more welcoming world for people who don’t fit in a box." At age 10, Emily Quinn learned she was intersex - she was born with XY chromosomes and a vagina and testes inside her body. As she writes, "Doctors said not to tell anyone, poking and prodding at me like I was a science experiment. It was lonely, shameful, and I had nowhere to turn. I needed someone to tell me that it would be OK, but no one was there." Emily Quinn was working at Cartoon Network when she came out as intersex in a PSA on MTV. This propelled her into the national spotlight as an intersex person, and in 2015 she shifted to full-time intersex activism work. Now she speaks about intersex issues in person and media all across the world. Through vulnerability, storytelling, and way too many jokes about her balls, Emily strives to create a more welcoming world for people who don’t fit in a box.
Watch her tedtalk: https://www.youtube.com/watch?v=stUl_OapUso Youtube channel | intersexperiences: https://www.youtube.com/emilord Website: http://www.emilord.com
Chapter 5
Moving forward: dismantling the binary
What can we do as individuals and as a collective to move forward, destigmatize intersex identities, and dismantle the binary?
Start with small steps. make biology classes more inclusive add neutral pronoun markers and titles on all documents and paperwork include “intersex� as an option for sex on forms share knowledge with those around you
Educate yourself. books by intersex authors like Born Both by Hida Viloria Contesting Intersex: The Dubious Diagnosis by Georgiann Davis Middlesex by Jeffrey Eugenides (not intersex) videos on intersex topics by creators like Pidgeon Emily Quinn The Interface Project.
Be inclusive. Include the voices of intersex people and groups in popular media Stop erasure of intersex identities in LGBTQIA+ spaces Decolonize your understanding of queer/trans identities—not everyone needs to use Western labels to be valid Do not make assumptions about sexual orientation or gender identity of intersex people Educate others about the flaws of biological essentialism and the gender binary.
Large-scale Policy: Federal ban on medically unnecessary surgery and procedures on the sex characteristics of intersex children. Ensure that intersex people and their families receive adequate counseling and support from culturally competent individuals. Ensure that human rights violations against intersex individuals are investigated and that victims receive justice through redress and compensation. Expand research on intersex individuals in order to increase public understanding and visibility Streamline the process of making changes to sex markers on legal documents Improve training of health care professionals on health needs and human rights of intersex individuals Ensure that intersex people and organizations participate in the development of research, legislation, and policies that impact them
By raising public awareness of intersex experiences, in addition to transgender and nonbinary identities, we can finally push science to align more closely with the goals of social justice, inclusivity, and decolonization.
closing note Thank you for taking the time to read and engage with this zine. I hope that you read something that caused you to reconsider your current perspective or at least gain some new knowledge. Remember that we are all at different points on our journey of learning and understanding. If you felt at all moved or informed by this zine, please share with those around you! I hope to never stop learning and spreading awareness about the LGBTQIA+ community. If you would like to respond to anything that I said, you can reach me at: heartnghiem@gmail.com With love,
Nghiem Nguyen
The art piece on the cover is a critique on Western society's obsession with biological determinants (e.g. chromosomes, genitalia, etc.) of gender/sex, especially with a binary system. Clothing is an important part of gender expression, but underwear is the most personal. I attempted to deconstruct the underwear so that they were no longer visibly "female" nor "male". If you can't tell, the patterns are inspired by fluorescent chromosomes. And if you look closely, not all of them are in pairs.
Cover art by Nghiem Nguyen