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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.

[–] 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.

Wrote it quickly - meant to say that it leads to different levels of androgens and estrogens than in typically developing women, not that it's a DSD, which is one way it's similar to CAH. CAH does come in different types, but my point was that it isn't something that I would want to put under some kind of limit regardless of the level of androgens and estrogens in that particular female individual.

As for estrogen, I was referring to how it leads to shorter stature (early fusion of epiphyses) and wider hips (less efficient running stance, more injuries). See here: https://ovarit.com/o/GenderCritical/64443/dsds-how-to-cut-the-gordian-knot/7bdea3b0-4f7b-46c8-a410-d853f967a231

This isn't particularly controversial. Here are some more if you're interested. I wouldn't be surprised (I don't have evidence for it) if that is the reason that the only major sport that women can do as well as men is long distance swimming.

increased injuries in women: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213798/ ( I also recall a few things on reduced calcium in women, which could also predispose women to injuries).

long distance swimming: https://pubmed.ncbi.nlm.nih.gov/32456109/