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A number of discussions have focused on which DSD conditions to consider allowing access to women's spaces. The primary issue of women being allowed to exclude men from spaces gets bogged down in how to draw the line precisely amongst DSDs and the matter isn't straightforward.

Sex differences, as we understand them, are due to two primary factors: the sex chromosome complement and androgen action. The "true intersex" population have atypical forms/combinations of these differences and can be challenging to sort out in the context of the real world where visual impressions have so much weight. This population is much much too small (on the order of 0.01% of the population) for any class effects and none threaten pregnancy. To be sure: conditions like 5ARD (Castor Semenya) are not "true intersex" here, all of the proposed rules below would exclude those males from women's spaces. None of these rules would, of course, tell anyone how to dress, what jobs they can do, how long to keep their hair, who to love etc.

Key "true intersex" cases

There are only a small number of "true intersex" cases to consider that makes the selection of rules difficult:

  1. CAIS - Insensitive to the most apparent effects of androgen action as it is known. Internal testes, no uterus. Cannot produce sperm.

  2. Ovotesticular disorder of sex development - Some have both gonads as mixes of tissue, some specific cases of one ovary and one testis.

  3. XX Male -Most have SRY attached to the X chromosome, a small fraction do not. SRY-ve XX males are believed to be due to the action of genes downstream of SRY that are thought to be (normally) gated by SRY but are not.

  4. Gonadal dysgenesis -Gonads do not differentiate. Female sex differentiation is not dependent on ovarian secretions, so these people will develop more similarly to females in childhood and can have a uterus. Swyer (XY) and Turner (X0) are classic examples. This could even include anorchia (born without testes).

  5. Mosaics and chimerism -Cells are a mix of karyotypes; numerous subtypes and reasons which can display a spectrum of phenotypes.

Exclusion Rules for Women's Spaces

An easy to interpret and apply exclusion rule is needed for most practical purposes. A rule that specified inclusion would almost certainly be difficult to reason about (perhaps that will be clear below).

Talking about sex in many of these individuals is a fraught matter when people do not know and understand molecular details of these conditions, and these people need be able to live in the world with privacy perhaps even legal fiction to make this possible.

Each of the obvious rules below work fine for typical males and females, but partition slightly differently amongst DSDs. "Born with" is presumed in each class.

  1. Potential to make small gametes This is a tricky rule to follow with "potential". Normally we use that mean to cover normal males who may not be producing gametes for any given reason...but all of the key cases do not have the ability to produce small gametes (e.g., CAIS). Do they have such "potential"? Hard to say. You'd have to let in XX males into female spaces with this rule, doesn't make a lot of sense.

  2. Has a testis Seems to make a lot of sense. Admits anorchia into women's spaces, excludes CAIS and some ovotestis.

  3. Has a penis All XX males are excluded from women's spaces as is anorchia. Swyer, CAIS etc. are not excluded from women's spaces here here.

  4. Constituent SRY "Constituent" to cover cases of microchimerism etc. and only SRY (vs. the whole Y chromosome) to capture SRY+ve XX males. SRY -ve XX males would also be in women's spaces though. CAIS would be male, but so would Swyer and some mosaic. This rule admits the very small set of SRY-ve XX males into women's spaces.

It's a lot of thinking to consider such a small population who, again, probably have tiny/no class effect on the class of typical 46,XX females. Any rule could potentially be unfair to some class in a way that we may not know yet.This is just a draft to outline the question. Perhaps there are some thoughts or corrections that can improve the presentation above.

A number of discussions have focused on which DSD conditions to consider allowing access to women's spaces. The primary issue of women being allowed to exclude men from spaces gets bogged down in how to draw the line precisely amongst DSDs and the matter isn't straightforward. Sex differences, as we understand them, are due to two primary factors: the sex chromosome complement and androgen action. The "true intersex" population have atypical forms/combinations of these differences and can be challenging to sort out in the context of the real world where visual impressions have so much weight. This population is much much too small (on the order of 0.01% of the population) for any class effects and none threaten pregnancy. To be sure: conditions like 5ARD (Castor Semenya) are not "true intersex" here, all of the proposed rules below would exclude those males from women's spaces. None of these rules would, of course, tell anyone how to dress, what jobs they can do, how long to keep their hair, who to love etc. # Key "true intersex" cases There are only a small number of "true intersex" cases to consider that makes the selection of rules difficult: 1. *CAIS* - Insensitive to the most apparent effects of androgen action as it is known. Internal testes, no uterus. Cannot produce sperm. 2. *Ovotesticular disorder of sex development* - Some have both gonads as mixes of tissue, some specific cases of one ovary and one testis. 3. *XX Male* -Most have SRY attached to the X chromosome, a small fraction do not. SRY-ve XX males are believed to be due to the action of genes downstream of SRY that are thought to be (normally) gated by SRY but are not. 4. *Gonadal dysgenesis* -Gonads do not differentiate. Female sex differentiation is not dependent on ovarian secretions, so these people will develop more similarly to females in childhood and can have a uterus. Swyer (XY) and Turner (X0) are classic examples. This could even include anorchia (born without testes). 5. *Mosaics and chimerism* -Cells are a mix of karyotypes; numerous subtypes and reasons which can display a spectrum of phenotypes. # Exclusion Rules for Women's Spaces An easy to interpret and apply *exclusion* rule is needed for most practical purposes. A rule that specified *inclusion* would almost certainly be difficult to reason about (perhaps that will be clear below). Talking about sex in many of these individuals is a fraught matter when people do not know and understand molecular details of these conditions, and these people need be able to live in the world with privacy perhaps even legal fiction to make this possible. Each of the obvious rules below work fine for typical males and females, but partition slightly differently amongst DSDs. "Born with" is presumed in each class. 1. *Potential to make small gametes* This is a tricky rule to follow with "potential". Normally we use that mean to cover normal males who may not be producing gametes for any given reason...but all of the key cases do not have the ability to produce small gametes (e.g., CAIS). Do they have such "potential"? Hard to say. You'd have to let in XX males into female spaces with this rule, doesn't make a lot of sense. 2. *Has a testis* Seems to make a lot of sense. Admits anorchia into women's spaces, excludes CAIS and some ovotestis. 3. *Has a penis* All XX males are excluded from women's spaces as is anorchia. Swyer, CAIS etc. are not excluded from women's spaces here here. 4. *Constituent SRY* "Constituent" to cover cases of microchimerism etc. and only SRY (vs. the whole Y chromosome) to capture SRY+ve XX males. SRY -ve XX males would also be in women's spaces though. CAIS would be male, but so would Swyer and some mosaic. This rule admits the very small set of SRY-ve XX males into women's spaces. It's a lot of thinking to consider such a small population who, again, probably have tiny/no class effect on the class of typical 46,XX females. Any rule could potentially be unfair to some class in a way that we may not know yet.This is just a draft to outline the question. Perhaps there are some thoughts or corrections that can improve the presentation above.

100 comments

[–] astro_terf 9 points Edited

I would exclude Swyer, CAIS and all other males with DSDs.

[edited to add: from sports, not necessarily other women's spaces - the lack of estrogen leads to a height and speed advantage in sports that is unfair to typically developing women. I wouldn't exclude Swyer, CAIS and other males socialized from birth as women as the problems of male socialization do not apply.]

Put simply, it's not simply the presence of male sex hormones/ testoterone during development that leads to the physical advantages that males have over females. The presence of female sex hormones during normal development during puberty and afterwards lead to physical disadvantages for women that CAIS males do not experiences.

For example, CAIS males have a height advantage that women do not. Estrogen causes epiphyses to fuse and so women tend to stop growing taller shortly after they reach puberty.

In addition, women develop wider hips to accommodate childbirth, but this is at the cost of an increased likelihood of injuries and a less efficient running stance. See https://www.sciencedirect.com/topics/nursing-and-health-professions/q-angle and https://www.livescience.com/59289-why-men-run-faster-than-women.html . Biological males who have never had any of the benefits of testosterone do not experience the disadvantages from estrogen, which would still give them a leg up on women.

[–] DetransIS 8 points Edited

I've never been so disgusted by this community until lately. I knew it'd go beyond Caster Semenya's male DSD, I knew it'd reach CAIS eventually and now judging by the replies to this very comment and a very unhinged women who hates anyone with a congenital condition of sexual development: Swyer. If you want to cast people like me off into men's spaces to retain your purity, then be my guest. Won't be long until you go for mosaics too.

De la chapelle syndrome "females" deal with azoospermia, which means they can't theoretically produce the male gamete by that logic nevermind their fully developed wolffian ducts and penis in the majority of cases. There are also De la chapelle "females" who are SRY negative, meaning the SRY gene you're all so afraid of isn't present. Taking it a step further, the so called testicles they have are "broken" as they again, cannot produce even the germ cells that are leading to this scare mongering about CAIS.. and there are also cases of De La Chapelle with ovotesticular tissue anyways. Also if your issue is with androgens? Guess you're going to be making some people in.. what, I believe it was Germany? Happy about their mutilation of children with classic CAH. They're already ripping the ovaries and uterus out and putting those kids on testosterone due to the excess virilization.

But hey, if you want to make it so males can develop a vulva naturally, have a uterus, a fully functional mullerian tract and even give birth? Go for it. Die on that hill. You aren't protecting women though by doing this and you honestly make it far easier and more appealing for TRA arguments. I can't believe I'm actually reading this from the same community that originally welcomed me and other women with DSDs but I guess maybe the TRAs were right, you were just using us for your points and now you found reason to dispose of us.. Seems neither side can be trusted.

[Go ahead and ban me for all I care, I'm probably deleting my account after this. Majority of you have disgusted me at this point and your science is as nitpicked as TRA science purposely neglecting countless studies in favor the same shit a subset of extremists are parroting. This shows by the fact you aren't talking with us who LIVE with these conditions and are listening to a speech pathologist a teacher, and an unhinged male detransitioner.]

Oh and what about her, she has the dreaded Y chromosome you all fear and shows biological sex isn't as simple as you or TRAs think it is.

That is an excellent case report that highlights the Gordian Knot nature of all of this. It sounds like you are saying that 3 is the right rule.

To a degree. I think phenotype is very important but your rule breaker on this one is 5-ARD and that's where it becomes more complicated, I'd say my stance is a combination of 3 & 1. CAIS cases aren't surface level like many people seem to think, sadly.

I can't believe I'm actually reading this from the same community that originally welcomed me and other women with DSDs but I guess maybe the TRAs were right, you were just using us for your points and now you found reason to dispose of us.. Seems neither side can be trusted.

I agree with this completely. I have CAH and I'm made to feel like a freak here. I menstruate regularly and have been pregnant, I'm exactly like every single other woman here. But purists want to expunge me from the spaces I actually belong in.

It's absolutely fucking despicable.

If you have had people tell you that you're not a woman, they are absolutely 100% wrong. CAH is a disorder that can ONLY happen in females, which makes it part of the natural diversity of all female humans.

[–] mittimithai [OP] male 4 points Edited

CAH is not considered a "true intersex" condition in the post. None of the rules would classify CAH females as males. The deceptive practices of telling CAH females they are males is indeed despicable. EDIT: And that practice is a good example of why "doctor certification" ought to be questioned.

Ah, I see where I wasn't clear - edited my post to clarify that I would exclude CAIS and Swyer males from sports (due to the physical advantages over typically developing women) but not female spaces (as they would not have the issues resulting from male socialization).

CAH is a DSD of female humans, just like PCOS, so I most certainly include them in women only spaces and in women's sports. As for mosaics, the same principles apply. The paper you reference has an example of an XY female who does have oestrogen production and has ovarian tissue instead of gonadal streaks.

Furthermore, the primary issue so far has been the presence of typically developing males who 'transition' at a later age and then compete in women's sports, as though the only issue is the beneficial effect of testosterone in puberty and not the detrimental effect of estrogen in terms of strength and speed.

[–] ProxyMusic 5 points Edited

CAH is a DSD of female humans, just like PCOS, so I most certainly include them in women only spaces

No, PCOS is not a disorder of sex development. Women with PCOS develop normal female anatomy and physiology during gestation. They have the usual XX and no SRY.

CAH comes in several different types, but the females affected by classic CAH might have external genitals that appear masculinized due to excess androgens, but with modern medical knowledge, genetic/chromosome testing and scans it can easily be established that they are female. There is no ambiguity.

as though the only issue is the beneficial effect of testosterone in puberty and not the detrimental effect of estrogen in terms of strength and speed.

What are you talking about estrogen having a detrimental effect in terms of strength and speed? Please cite some sources. I thought that estrogen is the steroid hormone that fosters female muscle development and maintenance. Never heard how it relates to speed, though. I will be interested to see what your links say.

Swyer Syndrome aren't male, that DSD can't even occur in "XX" as a carrier. It is a unique DSD to XY chromosomes. In medical literature the disorder is even coined as 46 XY Sex Reversal. Swyer have no physical advantages that other conditions related to disorders, or health also wouldn't have so to disclude them on this criteria is absolutely absurd and would lead to you having to go down any condition that can occur that'd lead to larger frames, increase in height, double joints, etc.

Classic CAH is indeed something that can only occur within those female and can become life threatening if ignored or treated haphazardly. However classic CAH can lead to excessive virilization that can lead to mistaking the genitalia for male genitalia at a young age until the woman grows into it, this is exactly what is leading to CAH cases being observed as male and put down that pathway.

What about Turner syndrome? They also have streak gonads similarly to Swyer Syndrome, it seems like you're focusing on the Y chromosome despite it being more complex then just that. I cited that paper because it shows that a female can have a 46 XY karyotype and who's to say if things didn't go right for other XY females[namely Swyer Syndrome] in development if they wouldn't have just became M33 Ablation XY females? This goes into what iffery though and no one here likes that.

Trans males have nothing to do with DSDs unless said trans male was born with male observed PAIS, or Klinefelter's or any of the other genuinely male disorders[Fully functional wolffian ducts, may have severe hypospadias] without question. I understand that TRAs weaponize XY females and CAIS cases all the time but this is not going to protect or safeguard women's rights by targeting these people in your policies. A Swyer female has a negligible advantage and that height matter you pointed out isn't even present within all cases of the disorder. Even if Swyer Syndrome females do have streak gonads, they undergo similar treatment to Turner syndrome patients with streak gonads as well: Hormone replacement therapy so they can develop and function healthily on an endocrine level.

What is your opinion and policy on individuals with DSDs in women spaces, sports and sex documentation?

This is a non-issue and will do nothing for protecting women, in fact it's hurting them.

You can clearly declare individuals with 5-ARD are male due to the way the disorder manifests itself and the fact that with medical assistance they can develop functional sperm and father a child. However there are instances where those with 5-ARD choose to stay in a "feminine" role due to learning of their disorder and being scared of suddenly having to change everything they know. 5-ARD itself is a delicate issue due to the fact its most common occurrence is in third world countries that are undeveloped and therefore they lack the tools and necessity for early screening of DSDs. That said the best way forward is to prep these children for the fact they were always boys and they have a rare disorder that will lead to their puberty starting later then most boys. How that is gone about? I'm not sure. 5-ARD are males and should not be competing in women's sports and I think cases where they elect to remove their gonads and stay in the role they were wrongly assigned into is a more delicate issue that deserves compassion given the impact of that choice. [Imagine finding out at 8 if you don't make a decision in a few years, you're "suddenly" going to become a boy, despite believing you were a girl your whole life?] 5-ARD is managed terribly and anyone should be able to tell you that, then you have the issue of shady individuals trying to capitalize on the disorder.

Every other DSD is strictly case by case and you should be focusing on the reproductive role in terms of gametes, which then you run into gray areas like CAIS where they didn't go down a female sex development path but also actively reject the male pathway as their germ cells if they even produce any within the internal testicles can become a cancer risk, especially as they age past 20. CAIS also gain no benefit or changes from testosterone, unless you mean aromatized testosterone which is pretty much estrogen in its effects and impact on the body. This is why even without hormone therapy and gonadectomies that CAIS will remain to have a female phenotype, no matter what. At most CAIS can end up taller which is comparable to numerous conditions permitted within the olympics that can affect stature and height. It doesn't lead to bigger lungs, wider ribs, stronger heart or anything like that.. CAIS are in fact shown to have complications associated with their condition, though they're rarer. This of course isn't factoring Hayley Haynes, another case where ovarian stroma was found and uterine muscle being found in other CAIS cases. If you ban CAIS for height? Hope you're ready to go down a huge list of other health conditions that lead to an increase in height or other advantages.

The fact I even have to defend Swyer just shocks me considering how the DSD manifests itself. They don't even start down the male development pathway, they have a Y chromosome and in many cases a SRY that isn't functional. Yet like in the case I cited above, it is possible for SRY to be present while going down a functional path of female development. Any exposure to testosterone they get will be coming from their adrenal glands which means they typically produce less testosterone then 46 XX females due to their lack of gonads, having streak gonads and all that. On top of that, Swyer develop a fully functional mullerian tract and AMH never activates. Numerous IVF cases have taken place where a woman with Swyer has been assisted in giving birth, even if the egg cell is donated it doesn't change the fact she has a body that supports that function and can do it. As well if a woman with Swyer takes testosterone, she's just going to virilize the exact same way as a 46 XX woman who thinks she's a trans man.

Speaking as someone with one of the more rare karyotypes out there I am not comfortable or able to side with the idea of this being the hill that feminists from this community want to die on. I understand women are tired of TRAs utilizing and weaponizing DSDs in their arguments for why trans identified people should be given their golden plate, but the big matter is there is no evidence connecting DSDs to innate transness, quite the counter evidence actually. Not to mention there's no evidence showing "trans" itself being a DSD, despite what TRAs claim and why many of us are trying to distance from "intersex."

In regards to sports I think cases like PAIS should be evaluated case-by-case and scrutinized heavily. Not to mention checked whether the PAIS was observed female, or observed male.. If the latter, it speaks for itself and shouldn't be permitted. If the former, androgen levels need to be maintained or a gonadectomy and no biological advantages should be present due to a roughly 80% or so resistance to androgens within the body. 5-ARD is a no brainer, absolutely not from this point. CAIS is also a no-brainer, there's no real advantage. Swyer? genuinely no difference from 46 XX women, and in the rare case of some genital virilization with Swyer it's more comparable to classic CAH at that point which none of you raise a stink about their "unfair advantage" despite how bad the androgen exposure in that particular DSD can get.

Sex documentation? Sex in humans is far more complex then just "XX, XY" karyotype and biologists are even siding with the fact it's based around what gamete your body is arranged around. However evidence around CAIS is tricky and studies are lacking on the intricate nature of the condition. Swyer are in fact coined as "46 XY Sex Reversal" in medical literature. Just like De La Chapelle is coined 46 XX Sex Reversal. These conditions, despite their karyotype and infertility have bodies that clearly are just missing -one- ingredient to all this, and in the case of Swyer that shows as there's a XXY variant of Swyer that was caught by pure coincidence that not only passed the karyotype to her daughter but also succeeded within fertility. This 47 XXY Swyer variant having an additional X chromosome leads to the problems of Swyer normally having, being resolved. I see no issue with phenotype being used in the majority of DSD cases for sex documentation but the fickle cases of 5-ARD and the most extreme versions of salt wasting CAH need approached better.