My first serious encounter with the idea that gender identity is deeper than a simple chromosomal definition came from a patient more than twenty years ago that was identified as a female from birth, but discovered after decades of marriage that her pelvis contained undescended testicles, and no ovaries or uterus. The country doctor who birthed her and gave her care over her lifetime felt it was appropriate to treat her as a woman all her life and she did not seek a new doctor’s opinion until her lifetime physician retired

The whole event of this discovery by her newly acquired GYN (who promptly informed her and her husband that she was not female) raised questions for everyone involved in her care about the concepts of gender identity and sexual preference, along with the ethics of rejecting an individual’s gender identity more than fifty years after their birth

The fact that I discovered more than twenty years ago, and which I have spent a bit of time researching, is that the common understanding in our culture of binary gender as male/female is not universal and also not really biologic. In fact, the understanding of binary gender is a shortcut, or more accurately a heuristic, developed by various cultures over our history as humanity to deal with the dominance of the two main presentations of genitalia in human creatures- anatomy that is more related to reproduction capability than actual identity or partner preference

While western culture has predominantly looked inside dungarees, jeans, kilts, or pantaloons to determine how someone fits into gender roles of society other cultures have allowed a more fluid approach to gender identity, focused on how the person recognizes themselves from the inside. This approach is actually more closely aligned with the concepts of value found in the story of King David in the Old Testament “man looks on the outward appearance, but God looks at the heart” (1Samuel 16:7)

So how does this work, and why does it matter? The fact is that biologically there is no such thing as only xy chromosomes making a male and xx chromosomes making a female. There are variations of chromosomes that are found in individuals that present anatomically in ways that don’t match their chromosomes. “Sexual characteristics”, as western medicine calls them, often, but not always, match the chromosomes found in the cells of their owners. This is because genes don’t make the person, they simply influence who the person becomes. While the father’s sperm does help nudge the early embryo into certain sexual characteristics, other events in and around the mother’s womb help seal how the baby develops, and how their body looks at birth. This process has been studied extensively to understand how intersex individuals (or in older, more vulgar terminology “hermaphrodites”) can occur

Intersex babies are interesting because sometimes they are born with the genitalia often identified with both sexes such as a penis along with a vagina, testicles along with ovaries and a uterus. There are variations, of course, and these are what produced the most intense research in more recent decades as the question of nature, nurture, or self-recognition was pretty much answered in how western medicine deals with intersex babies. The problem is, of course, if a baby is born “with both sets of parts” how do you decide what they are? After all, there are only two gender roles and our culture dictated that a determination must be made so the child will grow with a purpose to fulfill

So, the decision was often made to modify the child to match whichever preference the parents had, or whichever “parts” looked best developed. So, if the penis looked small they cut the kid up to be a girl, and if the penis was big the kid had its vagina sewed up, along with other modifications to make them a boy. To seal the deal, the parents raised the child as the gender that was chosen and no one would ever be the wiser, but researchers found that these children often did not “take” to their chosen gender as they grew into puberty and a great deal of work was done to find out why. The conclusion was that gender identity is laid in the brain before it is expressed in the pelvis. If something changes the process of adding a penis or deleting an ovary during fetal development the brain is unaffected and the child often “knows” from an early age who they really are

All this research finally led pediatricians to advise parents of children born “with ambiguous genitalia” to allow the children to determine their own gender identity once they could express it and only perform surgeries on their baby genitalia if it impeded proper bowel and bladder function. In other words- young children were to be allowed to decide their gender when adults couldn’t tell for sure because the children experienced less emotional trauma when they were allowed to be themselves. This is not to say that there isn’t emotional trauma in being a child who didn’t fit cultural norms, but at least parents weren’t forcing even more trauma on these children by telling them to deny their own deeply felt identity. It was determined that with gender determination in intersex children nature helps, nurture helps, but in the end the self-determination of the individual was best, and this self-recognition can happen at an early age

Now that physically obviously different children have led me to understand how gender identity occurs in fetal development I was led to wonder- is it possible that a baby can be born with only one set of genitalia, but have a brain that identifies with a whole different gender? Of course the answer is a resounding “yes”. In fact it is important to recognize that gender identity and sexual partner preference is no more genetically sealed than IQ. This is a good thing since the XX chromosomes which we use to identify females and XY chromosomes that we associate with males are not the only options. In one study of over 33,000 babies it was found that 1 in 448 children were born with anomalous sex chromosomes. In other words, if genes were to be used to determine what gender to pick, a decent chunk of those kids would still need to tell us who they were when they were old enough to recognize it themselves

And, let’s be honest, few of us want a lab test to dictate who we are. I am horrified by how often chromosomal studies are used to determine whether a baby is brought to term or killed in the uterus simply because the little body failed some genetic test. Many children who were still carried to term despite some “bad” genetic result were born without the defect seemingly predicted by the genetic study. While genes are often associated with certain outcomes, they do not guarantee that outcome. The human body is a complex set of systems that we are still struggling to fully understand

What do I suggest we do with this knowledge? Firstly, we learn grace. When we encounter someone who does not fit our predetermined categories I want us to take a step back and let them tell us who they are without trying to force them to be who we want them to be. “You look like a boy to me” could become “You are special to me”. No one truly wants to be the “odd man out”. It helps no one to assume that someone has “chosen to be different”

Secondly I wish we could stop looking at people based on whether they could impregnate or be impregnated. It’s becoming more and more clear that rigid gender roles have very little benefit in our society outside of deciding who should have the power, and gender doesn’t seem to be the best method of determining worthiness if history is our teacher

Thirdly I ask my religious friends to look at how much their concepts of gender roles are directly from their religious doctrines and how much is imposed by their own desire for simplicity. For example, did the Ancients write that humans were “created male and female” as a dictate or a simple description of what most often is? If your god is responsible for the human design that is sometimes not clearly male or female could it mean that your god is leaving room for variety? No holy scripture completely defines every aspect of reality, so we must assume the deity of that scripture intends that we also learn from the rules of nature that the deity provides us to observe. If this is the case, then when we learn that the human body so craftily designed does not conform strictly to our binary gender rules, we can allow ourselves to accept into our religious fellowship people who do not conform to our strict gender roles

And finally- let’s put to bed the fear that exposure of little children to LGBTQ+ ideas and identities will “create” sexually related mental disorders. As I discussed earlier people become who they are despite external influences. It’s not our jobs to make people fit into certain boxes based on some strict set of rules, but it is our job to help them accept themselves as individuals worthy of love and acceptance

I didn’t provide any references here because the volume of material is already so much, but feel free to look it up yourself. The data is out there, and it is quite extensive. Don’t take mine or anyone’s word for it. Your brain is capable of understanding it