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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

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.

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.

Swyer individuals don't experience female puberty, are taller than the average female since they may not get diagnosed until 16 or so (most girls get their periods by the time they are 11 or 12) and don't develop widening hips at that age. Wouldn't that give them a physical advantage? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664218/

CAH females being miclassified as male is something that needs to be corrected, because they are 100% women.

Turner syndrome is a DSD of females, and moreover, they are likely to be shorter than typically developing females ( https://en.wikipedia.org/wiki/Turner_syndrome ) . I don't see why Turner syndrome is relevant to this discussion though. They are females, not males (i.e. lacking a Y chromosome). Could you clarify as to why the presence of a Y chromosome should not be germane to this discussion? I am not saying that it's the only thing that is relevant.

The example of the Swyer individual you gave had ovarian tissue instead of streak gonads. The point I am trying to make is not that we need to exclude or include specific individuals with rare DSDs, but that when the cases of rare DSDs are used to justify typically developing males who have 'transitioned' to be allowed into women's sports, that the issue isn't simply about testosterone giving them an advantage (over their lifetimes), but that they have not experienced the disadvantages that typically developing women have from estrogen.

Swyer individuals don't undergo any puberty due to having streak gonads and not being able to produce any hormones aside from their adrenal glands. I also wouldn't call a neglected endocrine system an advantage of any sort. The series of cases you linked actually suggests that these girls are essentially receiving the "puberty blocker effect" except it's natural due to the fact they have no gonads and therefore produce no sex hormone except from their adrenals. Some of the cases in that article you cited even stress that some girls with Swyer had dysgerminoma, not streak gonads as well.

I agree on the matter of CAH, it's another condition often weaponized by TRAs arguing "women can have penises" due to their virilized clitoris, which as an adult resembles nothing comparable to an adult male micropenis, or penis.

I brought up Turner Syndrome to illustrate the issue with your argument and it's even in the original post. Streak gonads are not a phenomenon that's isolated to Swyer Syndrome and it shouldn't be criteria to say whether someone is male or not, especially when streak gonads can and do occur in Turner Syndrome. What makes streak gonad Turner Syndrome female, and Swyer not? Both conditions are very similar except one has much less development due to the nature of only having a monosomy. I linked that case of XY female earlier to illustrate to you that a case of M33 Ablation has an active SRY gene region but it's completely rendered inactive due to other factors. Cases of Swyer vary but in all cases there is no element of male development in the womb, contrary it's the opposite given they develop functional mullerian ducts and a uterus. It's less about the Y chromosome being a factor and more on the internal workings of said Y chromosome, take my own case for instance despite being a mosaic I am SRY negative. There are also instances of plenty of Swyer cases that are also SRY negative.. but SRY isn't the end all be-all determinant either.

Shut those cases down because they have nothing to do with one another. How is a rare DSD of the 46 XY variant comparable to a male who grew up in a healthy body and willingly chose to castrate themselves? Not to mention most the cases you are going on about do experience the disadvantages gained from exposure to estrogen, some actually end up worse given how detrimental the effects of having a suppressed endocrine system can be for multiple years when you have streak gonads.

My point is, trans males have absolutely nothing to do with DSDs and in the rare instance a trans male does have a DSD the DSD tends to be very easily male observed and proven, like XXY Male[Klinefelter] or male observed PAIS/MAIS. All this is doing is just leading to a purity test that is being unfairly cast upon women who never asked to be born with the DSD they're being subject to this testing over...