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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

I think it is extremely important for people to remember that DSDs are extremely complex and that it isn't the same situation as dyadic people having gender dysphoria. People with DSDs have been treated as political pawns and often experience social trauma due to lack of understanding of conditions. It's important not to punch down and remember we are talking about complex medical abuse cases.

Chromosome centered sex determined isn't going to work in some of these cases. XX males wouldn't make sense in women's spaces and they themselves would be medically harmed by being medically treated as dyadic women. I have zero issue with CAIS women in women's spaces with the rare exception of spaces where the exclusion is due to lack of need. CAIS women do not have the same medical needs as dyadic males and they are in danger being placed in male spaces.

We also need to be aware of what being treated as a scary Other does to people who have an anatomical medical condition. It isn't good psychologically and like, I don't endorse a culture where people feel embolden to utterly dehumanize people who they are trying to vet. The science behind this stuff is complex and it should take any honest/sincere person hours of reading to begin to grasp it. The advocates who have DSDs are becoming burnt out because multiple sides are trying to weaponize them. The trans community does not treat people with DSD well at all and furthers their material oppression via demedicalizing what are medical conditions.

Many have severe medical trauma, many have been surgically harmed as infants due to patriarchal "reasoning" over their actual health. I've seen more vitriol directed at people with DSDs than major influencer youtubers in some cases. Sorry but, that gives me reason to suspect punching down/bullying behavior. Which hurts both the targets and wider organizing because people who want to make real systemic impact KNOW how dangerous indulging bullying behavior is.

People with DSDs have been treated as political pawns and often experience social trauma due to lack of understanding of conditions.

Radical feminists are equally as guilty of this. It's just as bad here as it is on trans forums. Sometimes it's actually worse.

I have CAH and constantly have to prove my womanhood to the eugenics and purity obsessed radfems who want to exclude me, despite menstruating regularly and getting pregnant naturally multiple times.

I've never seen anyone on this forum describe female with CAH as "not women". Can you show an example?

[–] Lipsy #bornnotworn 14 points Edited

I'd be comfortable sharing public or private spaces with anyone who has been raised and socialized from birth as a Girl growing up into a young Woman.

Sports are a different issue. Because TRAs have shown their hand over and over again—they're incapable of honoring any sort of compromise; they'll ALWAYS do their best to turn compromises into slippery slopes, and slippery slopes into frictionless slopes—the only reliable division of sports at elite levels is to exclude all of the above intersex cases from Female competition, and require them to compete in an "open" division.

How would you propose certifying this status? What would you do with cases of (perhaps completely normal) males being deceived by parents and being socialized from birth as females?

[–] Lipsy #bornnotworn 7 points

well, even in the current encroaching dystopia, the sex recorded on a birth (or foundling) certificate at or around the time of birth (or registration of a foundling orphan) is still going to be a reliable proxy for how the child is socialized through early years.

The only exceptions would be the theoretical deceptive-parenting situations you alluded to... Tbh I'd have to think through that some more? But if the world gets so fucking insane that that type of situation becomes any more than vanishingly rare (the only documented case I can immediately recall is that twin that John Money abused and had butchered, and, can it rlly be said that he was raised as a normal Girl?), then, it's beyond me to even envision what would pass for 'normal' socialization in that nightmare world and all bets are off.

Thank you for taking the time to think about it!

To be sure, the deceptive parenting situations are not at all theoretical, no shortage of examples of transing of young children described in ovarit posts.

We have eyes and ears, we know that's a man. Someone parents lying to him his entire life isn't our problem to worry about or fix and has nothing to do with the conversation at hand.

[–] mittimithai [OP] male 3 points Edited

No that isn't quite fair. We've seen examples of people testifying that they were "raised as girls" when they were not. Males, I guarantee you as one, will testify to this if it means access to women's spaces and it could be next to impossible to falsify.

A fair objective rule is indeed the very subject to the discussion at hand, 'we just know'-type positions are not satisfactory to many and don't form the basis for a policy.

I agree.

[–] Lipsy #bornnotworn 3 points

The other purpose of my proposal here is to put forward something that any random person on the street could fully understand right away—unlike anything that differentiates on the basis of obscure and vanishingly rare medical conditions.

All this talk about which sex a person “acts like” and the “advantages of androgens” and the “disadvantages of estrogen.” Yikes.

These people are a TINY fraction of the population. These kinds of conversations come across as distractions. Can’t we use common sense?

[–] mittimithai [OP] male 1 points Edited

Feel free to suggest a "common sense" rule. As you can see, it isn't so easy.

I’m gonna get downvoted for this, but if someone passes for female, we can share a bathroom. This includes behavior and actions. For example, Nikita Dragun looks pretty female but acts like a male fetishist.

But you obviously can't easily certify behavior. If we did have some sort of magic "safe vs. not safe" sorting hat for men, we wouldn't need to separate by sex. Sex is the best sorting hat we have

[–] 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.

[–] mittimithai [OP] male 2 points Edited

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.

Swyer need exogenous estrogens for puberty. Best I can see is that Swyer individuals have female typical hips with that treatment; "Girls with Swyer do not undergo a typical female puberty because they lack ovaries, which in typical female development will cause female pubertal development of breasts, wider hips, menstruation, etc."

EDIT: I managed to read that wrong. Most little dribbles I find suggest that Swyer do not undergo typical female hip and breast development.

I didn't undergo typical hip and breast development, both are under developed. I'm also taller than average. I menstruate every single month and have successfully become pregnant without any assistance, multiple times.

But according to the first two sentences I wrote, I should be barred from female spaces and events?

Pure delusion and hatred. That's all it is.

[–] mittimithai [OP] male 3 points Edited

(I may have missed it, I presume you testified to Swyer status EDIT: I see in another comment you are testifying to CAH status. None of the rules would exclude you from women's space as you are, uncontroversially, female (this is despite the medical practice of deceiving female CAH patients that they are male)

Thank you for participating in this discussion. I think the discussion on the other side is more ignorance than hatred, Swyer is very difficult to understand without some understanding of the molecular biology of sexual development. Many people have heard things like "a Y chromosome makes you male" (it of course does in virtually all but a tiny fraction of us). I hope your testimony helps other people understand the condition so it helps with resolving this issue which is, so often, used to mire discussion.

I wish there was a “save” option for comments. I would have liked to save your comment to reference it again in the future.

I am much taller than average with much thinner hips. I have a hormonal disorder where I don't produce the average amount of estrogen. Should I be disqualified from women's events because of this? Because that's essentially what you're saying.

They look like and have been treated their entire lives like women. You seriously wouldn't be able to "clock" these people because even THEY don't know about it a lot of the time.

[–] astro_terf 2 points Edited

it isn't about clocking people, it's about having a clear demarcation - does CAH and PCOS lead to different levels of androgens and estrogens in women? Yes. But it's part of the normal variation you see in women/ female humans, so it's not something that should be controlled. That is, women with CAH and PCOS should be included in women's sports with no restrictions.

This is another article indicating that the height advantage comes from the absence of estrogen, not the presence of androgens, in CAIS males: https://www.endocrine-abstracts.org/ea/0015/ea0015p199

[–] visits_radio 10 points Edited

I wrote a comment in the CAIS discussion thread about my opinion on the issue.

If a male resembles the female phenotype so closely that he is misassigned the wrong sex at birth and is raised and socialized as the opposite sex then he can keep his legal documentation as female and therefore use female spaces (as there are no laws forcing individuals with DSDs to correct their sex after diagnosis).

The only exception to this is sports as almost all male DSDs (except CAIS) do not eliminate the male physical advantage. Males with DSDs would fail any sex testing like cheek swabs (and I support sex testing in higher-level athletics) which would bar them from elite sports.

[–] ProxyMusic 4 points Edited

If a male resembles the female phenotype so closely that he is misassigned the wrong sex at birth and is raised and socialized as the opposite sex then he can keep his legal documentation as female

One small flaw in this line of reasoning is that it assumes all the world's children are checked out and officially "assigned" a sex, or have their sex recorded, by medical professionals at/soon after birth and/or in childhood - and/or that all children get "legal documentation" stating their sex such as birth certificates early in life close to the time of birth as well. But this is not the case for many people on the planet even today.

The XY DSD athletes who've flooded into women's elite international track & field in such large numbers in the 21st century all were born to poor mothers/families in either sub-Saharan African countries or in India and none of them received either medical checkups or birth certificates as children.

In many of the world's poorer and "less (technologically) developed" countries, home births are still common and infants and children do not customarily get "well child" checkups or any other medical care growing up unless they are extremely ill or have a condition that is so unusual and obvious to others that it causes great alarm to parents, families and local communities. So parents of kids with severe facial or limb deformities or a life-threatening condition would seek out medical help for them. But this would not be the case for parents of kids who are healthy and appear totally normal - or for kids who are healthy but were born with genitals that don't conform exactly to the standards that male medical doctors and sexologists like John Money in certain technologically advanced Western and white-majority countries decided that "normal" genitals should look like.

Moreover, many of the world's poorer countries have long had very low rates of birth registration of children. And whilst rates of birth registration have been increasing globally over the past 40 years, often due to UN and national campaigns promoting birth registration, there are still hundreds of millions of people on earth who grew up without obtaining birth certificates even in the current data-driven "information age" and era of identity politics.

For example, the time that Caster Semenya was born 31 years ago, Semenya's birth was not registered nor was a birth certificate issued for Semenya because at that time the vast majority of black people in South Africa did not register the births of their children with the then-apartheid government or obtain BCs for them. On the contrary, under apartheid (and before it was instituted in 1948 too), black parents in SA often took pains to hide the births/existence of their children from the racist white SA government. If/when black people got birth certificates, it was usually when they turned or neared 18 and needed to have government-issued passes and permits to work or travel - or they wanted to get a passport so they could leave the country either permanently or for a while as many black intelligentsia and political activists were forced or decided to do during apartheid.

One of the aims of the presidency of Nelson Mandela was to get black South Africans to start trusting the post-apartheid SA government enough to start registering their children's births and obtaining BCs for them. Mandela's campaign has largely succeeded. In recent years, as many as 89-92% of births in SA are registered with the government either the year of birth or within a few years.

https://munkschool.utoronto.ca/wp-content/uploads/2016/11/South-Africa-Reach-Report-compress.pdf

But still, many people in SA born in earlier generations remained unregistered until they reached their teens or adulthood. Semenya's first birth certificate was only issued in April 2007, when Semenya was already 16. As far as I can determine, this is the first "legal documentation" Semenya received in his lifetime saying "FEMALE." And it just so happens that Semenya's BC was issued by the very same government whose (corrupt) sports officials had already scouted and identified Semenya as a potential Olympic champion and world record holder in women's events - if only they could convince the world to believe that Semenya is a female with a disorder of female sex development rather than a male with a disorder of male sex development.

All the XY DSD athletes who've made such big inroads into women's elite international sports since the IOC and IAAF stopped mandatory sex chromosome and SRY of all athletes seeking eligibility in women's events in the 1990s have come from countries/regions with very low rates of birth registration.

https://data.worldbank.org/indicator/SP.REG.BRTH.ZS?locations=ZA

Half of the world's unregistered children live in sub-Saharan Africa. In 2020, the UN reported that "half of all African children are unregistered, but levels vary widely across regions and countries."

https://www.unicef.org/wca/media/5526/file/AU-Birth-Registration-Statistical-Brochure-Nov-2020.pdf

One of the sub-Saharan countries where rates of birth registration have remained low even in the 21st century for children who are black, poor and from rural areas is Namibia, which until 1990 was under the rule of South Africa. Not coincidentally, Namibia is also the home country of Christine Mboma and Beatrice Masilingi, both born in 2003 and now age 18. For those who don't know their names, Mboma and Masilingi are the most recent XY DSD entrants into women's elite international track who've been smashing women's records and cleaning up in prizes since they first were put on the world stage in mid-2021. The Namibian press has dubbed the two XY DSD runners who are now Namibian national heroes "the two terrific turbo teens."

But even in sub-Saharan African countries where the birth registration rates have increased in recent years so they are now relatively high, the opposite was the case until not long ago. Take, for example, Burundi, where two-time Olympic medalist in women's running Francine Niyonsaba is from. When Niyonsaba was born in 1993, a brutal, extremely bloody civil featuring the sort of butchery that occurred next door in Rwanda and led to "the Rwandan genocide" was breaking out in Burundi. The Burundian civil war lasted more than 13 years. During that time, there was virtually no functioning government administration. Moreover, during the Burundian civil war little boys as young as 5, 6 and 7 were routinely rounded up from households by menacing, heavily armed militias and forced to become child soldiers. In that situation, Niyonsaba would have had no chance of obtaining a BC as a kid, and Niyonsaba's family would have had a mighty powerful incentive to tell Niyonsaba that he's a girl and to try to pass off and treat him accordingly, at least when others where close by.

Outside of sub-Saharan Africa, India is another country with a high number of XY DSD athletes in women's track and field. Not surprisingly, in India rates of birth registration are very variable, with stark differences between rich and poor. In 2021, a report "Birth registration in India: Are wealth inequities decreasing?" in the journal Social Science & Medicine Population Health found that in India:

National birth registration coverage was 41.2% in 2005 and improved to 79.6% in 2015. Between 2005 and 2015, coverage among children in the poorest quintile (Q1) improved from 23.9% to 63.8% while coverage among the wealthiest children (Q5) improved from 72.4% to 92.8%. Although the absolute wealth inequity decreased from 48.6%-points to 29.1%-points, children in Q1 still had levels of coverage in 2015 that were lower than children in Q5 in 2005.

https://www.sciencedirect.com/science/article/pii/S2352827321000033

I believe in sex testing in elite athletics to bar males with DSDs from competing.

[–] ProxyMusic 3 points Edited

So do I. When it was discontinued, the vast majority of female athletes polled at the Olympics in 1996 said they wanted it to continue and thought it was fair. But the IOC decided to join with the IAAF and abandon it anyways in order to placate XY DSD athletes and the small minority of females who had doubts about it.

[–] mittimithai [OP] male 5 points Edited

To be sure, CAIS can be diagnosed in utero so that many cases will not be mis-assigned. Would you still allow them access based on appearance even though it was known before birth that they were a genetic male with CAIS?

Males with DSDs that are likely to be socialized as females due to their phenotype closely matching the opposite sex are the only cases where I think incorrect sex documentation should be tolerated. If a condition like CAIS is detected in utero then I think the mother and her doctor should discuss the best upbringing and outcome for her child and even choose which sex to be documented on the birth certificate.

I don't think this information should be hidden from the child growing up and this should be handled with nuance and care to help the child understand his medical condition. And I don't support any unnecessary medicalization and surgery for children with DSDs.

Good points, but the scenario you depict still leaves out all the many millions of women and girls around the world who go through pregnancy and birth without ever seeing a doctor. And it leaves out al the hundreds of millions of people on the planet even today whose parents did not register their births and thus never obtained birth certificates for them as babies or children.

[–] mittimithai [OP] male 2 points Edited

Also, Swyer genetic males don't have testes (and have a uterus). No androgen action but they do have the Y chromosome. Would you call Swyer a male DSD?

I believe Swyer syndrome is commonly caused by mutations in the SRY gene. It is the SRY gene that initiates male development. So even though individuals with Swyer syndrome have XY chromosomes, they are and develop as female.

[–] mittimithai [OP] male 5 points Edited

Only about 15% are attributed to SRY mutations. Swyer syndrome suffers from gonadal dysgenesis, they do no get ovarian tissue and will lack the ovarian secretions required for puberty. They do have a uterus but, no potential to make large gametes. They have Y chromosome action (one of the two primary sources for sex differences). They certainly will look indistinguishable from females in many ways (presuming they get exogenous hormones for puberty), but it's not quite as simple as they "develop as female".

EDIT: A quick look will show you that Swyer patients are often tall. I'm not aware of a formal study, but this is very plausibly attributed to Y chromosome action; height is known to be a very genetically determined thing.

How to cut the Gordian knot?

Recognise that we don't primarily care about people's genetic sex.

Sex is, definitionally, reproductive role. Someone with CAIS is infertile, but conceivably could father a child with some assisted reproductive magic, so is technically an infertile male.

But we don't care about reproductive role - we care about whether they're a man or woman. It's their physical attributes and behaviour. We care about whether they have a male or female phenotype most of the time.

Transwomen are clearly not women - their entire body and behaviour shows that. Even male eunuchs or those who undergo puberty blockers + cross-sex hormones do not end up really resembling women.

CAIS women basically are women though. Their genetics may be a flawed version of a man's genetics, but because of that flaw they developed into a female-type body, albeit infertile. They will be perceived as women, and as far as I know, statistically act like women. Or at least a hell of a lot closer to women than men.

If you are going to insist CAIS women are men because of some hidden "manness" that is imperceptible to people they interact with, then that's basically an argument for accepting transwomen as women - they also claim to have some hidden "womanness" that is imperceptible to people they interact with. This is just the mirror image of the "gendered soul", something imperceptible that makes you something other than what you clearly are.

But it's worse - you're seeking out this hidden stain in others to cast them out.

I am a bit confused by the statement "Someone with CAIS is infertile, but conceivably could father a child with some assisted reproductive magic, so is technically an infertile male." Because my understanding is that they are beyond infertile and do not produce gametes at all. The type of technology to assist them would probably also be able to create sperm from dyadic females as well. (Taking genetic coding and putting it into artificial sperm gametes)

I agree it is important not to essentialize these things. and I agree with this "But it's worse - you're seeking out this hidden stain in others to cast them out."

I've literally never had severe issue with a CAIS women in my entire life. I have never been materially harmed by inclusion of CAIS women.

Indeed spermatogenesis is androgen receptor function dependent as we understand it, and CAIS do not have that function.

"In adults, Sertoli cell stimulation by testosterone, locally produced by Leydig cells under the control of LH, is required for spermatogenesis. At minipuberty, Sertoli cells do not express androgen receptor (AR) and are unable to promote germ cell maturation despite the presence of FSH, LH and testosterone [5]. Onset of AR expression in Sertoli cells seems to be a critical step for initiation of spermatogenesis" https://bacandrology.biomedcentral.com/track/pdf/10.1186/s12610-021-00150-8.pdf

[–] ProxyMusic 2 points Edited

But just to be clear about that paper you cited: what is observed "in adults" and in adult cells is not necessarily true of infants and infant cells. Everything I've read on this suggests that there's a dramatic difference in the testicular tissue of newborns and babies with CAIS and the testicular tissue of persons with CAIS after age two - and that if there's any activity at all linked to possible spermatogenesis or the potential for such, it's been only found in the testicular tissue of CAIS patients very early in life - usually under age 1, but perhaps to age 2.

Previous pathology/histology reports describing testicular tissue biopsy samples or tissues of whole testes taken from persons with CAIS age 0-2 years has caused some researchers to suggest that persons with CAIS and some other DSDs might eventually be able to achieve fertility if they have testicular tissue removed early enough in infancy and it's cryopreserved using techniques that have been developed for baby boys with cancers. That's what Oxford physicians say in a 2019 paper called "Establishing reproductive potential and advances in fertility preservation techniques for XY individuals with differences in sex development". Some excerpts:

Discordance between gonadal type and gender identity has often led to an assumption of infertility in patients with differences in sex development (DSD). However, there is now greater recognition of fertility being an important issue for this group of patients. Currently, gonadal tissue that may have fertility potential is not being stored for individuals with DSD and, where gonadectomy forms part of management, is often discarded. The area of fertility preservation has been predominantly driven by oncofertility which is a field dedicated to preserving the fertility of patients undergoing gonadotoxic cancer treatment. The use of fertility preservation techniques could be expanded to include individuals with DSD where functioning gonads are present.

These data revealed fertility potential by the presence of germ cells in all patients with CAIS, mixed gonadal dysgenesis (MGD) and ovotesticular DSD included in the study.

All six patients with CAIS had germ cells present in their testicular tissue (62 ± 111) (mean ± SD number of germ cells/mm2). In CAIS gonads Sertoli cell nodules and areas of hyperplasia contained no germ cells but all six of these patients had germ cells present in areas between nodules.

This study reported that 55% of patients who thought they were unable to have biological children expressed a desire to have had fertility treatment in the past or have it in the future. In addition, 40% indicated that they would like to try new techniques for fertility treatment in the future.53

Fertility preservation has been driven predominantly by oncofertility which is a field dedicated to preserving the fertility of patients undergoing gonadotoxic cancer treatment. As there is growing evidence of individuals with DSD wishing to retain the potential for biological fertility,2, 53 the use of fertility preservation techniques could, and should, be expanded to include this group.

For prepubertal boys who do not yet produce spermatozoa, freezing of immature testicular tissue to preserve SSCs for future use, has been suggested and is considered ethically acceptable.73, 74 Several teams have developed cryopreservation protocols for human immature testicular tissue.

https://onlinelibrary.wiley.com/doi/full/10.1111/cen.13994

I've read a couple of accounts like this, and I wonder if in their effort to be cutting-edge and show kindness to persons with CAIS and other DSDs, these scientists are actually being rather cruel by getting DSD patients' hopes up with talk of pie-in-the sky possibilities. And by doing research that underscores that persons with CAIS are male genetically with male gonads, which is something it sounds like some people with CAIS do not to be reminded of and would prefer that people who don't have the condition and aren't directly involved in treating patients with it not discuss either.

Re: the paper you linked to: one of the issues that popped out to me immediately is that in the abstract the authors take pains to describe the numbers and ages of nearly all the various groups from whom they obtained the testicular tissue that they compared. Except that is, for the CAIS patients. The number of CAIS patients included and their ages when the testicular tissue was taken from them was curiously absent from the abstract. I had to read the paper line by line until I finally found the point were the authors reveal that their study used

testicular tissue from 4 patients with complete androgen insensitivity syndrome (CAIS) aged 3 months, 14, 18 and 20 years.

From reading previous research on this, I was surprised that they were lumping these four CAIS patients together. Because it seems well established by now that the nature and activity of the testicular cells and tissue of CAIS persons at age 14,18 and 20 will be very different to the nature and activity at 3 months - and only in the case of the 3 month old would there be any reason to expect to see cells and activity with any remote chance of being connected to possible primordial or precursor sperm cells.

At any rate, I would imagine that for every positive aspect this sort of research might have, it could also lead to negative psychological aspects. ClareCAIS explained on Mumsnet that she is very concerned about the terrible impact that things Exulansic has said about CAIS would have on teenagers newly diagnosed with the condition, or older teens struggling with coming to terms it. But I'd think that it would also fuck with these poor kids' heads if they came across scientific papers, or met doctors, discussing primordial sperm germ cells found in CAIS testicular tissue and saying that with ART CAIS persons might one day be able to father children.

Sorry, I did basically mean magic - technology that doesn't exist yet. They have male genes so if there was some way of transplanting those genes into sperm or whatever, then they could be a genetic father.

Ah that makes sense. Still, that level of magic technology would enable lesbian couples to have biological children as well.

But it's worse - you're seeking out this hidden stain in others to cast them out.

Exactly. There's a not small amount of radfems that are downright obsessedwith this.

It's like a weird eugenics nazi obsession with finding and eliminating all the genetic fuck ups.

I hope they're not "radfems" :(

I don't see what the purpose of it is, unless it's just to manufacture an artificial purity spiral.

"If you won't say anyone with a Y gene is a man, you're really a secret TRA!"

The problem is that, yes, TRAs spout bullshit about DSDs, so some of this stuff does sound like their bullshit. "Sex is more complicated", blah, blah, blah. So maybe it sounds like "TRA rhetoric". So I can see a hardliner having a similar instinctive response to TRAs who say things sound "a bit TERFy".,

But the core of the TRA DSD bullshit is not usually the DSD discussion itself - it's that it applies to them.

CAIS individuals' sex may be complicated (or at least unusual).

But trans people's sex is not.

(And nor is pretty much any adult person's - if you have any of these really edge-case DSDs like CAIS it will become apparent by puberty).

You can basically not worry about DSD individuals. If someone looks like a man, they're a man. If someone looks like a woman, they're a woman. If they're really that ambiguous, then let them be. There are infinitesimally few such people.

It's not complicated. It would be if trans people actually passed, but they don't. Some are acting as if we need some genetic test to spot the trans person, and that CAIS has to be the man side of the line (for some reason).

Even if you did want to draw a hard line, and not have a grey "whatever" area, there's no reason not to draw it in a sensible place, with CAIS on the woman side. (As athletics DSD rules have already done, putting PAIS, 5-ARD and others on the other side.)

For those who advocate the position that "assign by what you look like", here is a report from doctors encouraging the male assignment of 46,XX CAH females.

https://academic.oup.com/jcem/article/95/10/4501/2835100

Some of the research papers in the area of DSDs are written by people whose views are so sexist and regressively genderist that it makes my hair stand on end. To wit:

There has been a shift toward male gender assignment in 46,XY DSD patients with poorly developed male genitalia, although the consensus recommendation for male assignment included only two specific diagnoses: 5α-reductase deficiency and 17β-hydroxysteroid dehydrogenase deficiency. This is a major departure from the optimal gender approach’s recommendation that those with small penises be reassigned female.

How can these people write this without realizing or commenting that this reflects one of the major sexist biases of genderist dick-obsessed medicine that is so insulting to female people - and which has led to so much medical mistreatment of persons with DSDs and to the problem of so many athletes like people like Caster Semenya competing in women's sports? Any male with a small penis should be considered to be female and reared and seen as female. Sheesh and yikes.

Most informed clinicians now recommend a male gender assignment for any virilized 46,XY patient with testicular function, even when the diagnosis is unknown. A basis for this shift comes from outcome information of undervirilized 46,XY patients who underwent feminizing surgery in infancy but nonetheless maintained a male gender identity (20).

Yet they go on to recommend that people they know for certain are female should be raised as male if their genitals were virilzed during development. It's the John Money approach to the Reimer twins all over again, only flipped around. Instead of telling a male he's female, these doctors say let's tell a female she's male. All because all these doctors can think about are dicks. And coz they're homophobic particularly in regards to female-female sexual relations:

When compared with their less virilized CAH counterparts, studies of highly virilized CAH women show that fewer have had a spouse, partner, or sexual experiences with men (38), and more have sexual difficulties, decreased sexual activity, fewer personal relationships (39, 40), and a lower quality of life (27, 39). [Presumably coz of not any or not enough sexual experiences with men?]Although most are satisfied with the female gender, a significant percentage manifest a homosexual orientation, whereas typical male gender role interests and male-type childhood behavior are common (22). Although the incidence of sexual experience is lower in these women, the rates of bisexual/homosexual fantasy are higher than in controls (30). This is consistent with a relationship between androgen exposure and sexual orientation (24).

When the basic factors for gender assignment (Table 1) are applied to the 46,XX CAH patient with essentially male genitalia, the male external genitalia, the prenatal CNS androgen exposure, the masculine physique, and capability of satisfactory adult sexual function [meaning faux heterosexual function] all make compelling arguments for male assignment when parents support it.

For the case report presented, parents mandated a male sex of rearing for their infant. They have been compliant with the medical recommendations for managing his CAH and have supported his male sex of rearing. [Sounds like these doctors believe they are the boss men giving the orders here, and the parents are in a minor supporting role.] Currently, this boy has well-developed genitalia (Fig. 1B), is approaching the age of puberty with apparent well-established male identity, and is involved in sports and other typical male activities. His parents realize that outcome is not yet fully realized. The lack of outcome data is clear, and studies and reports expanding such are sorely needed.

If the outcome of what has been done to this unfortunate child is not clear yet, why the rush to write up and pubish this report now? Seems a bit like counting your chickens before they've come home to roost.