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The usual pattern of human foetal development results in a 3-part alignment, as follows Either: This is extremely rare and only one or two members of our group are in this situation. The old term used in medicine for this situation is a hermaphrodite. Note, however, that a hermaphrodite, in the sense understood by most of society, is a purely mythical creature from ancient literature, one that supposedly has a complete working set of both male and female internal and external organs such that the individual can, in theory, impregnate itself. This is not humanly possible. Unfortunately medicine took over this literary term in the days before genetics was understood and used it as a medical term, to refer to these individuals who have both ovarian and testicular tissue internally an ovo-testis and who, as a result, can have ambiguous external genitalia. Not quite so rare Note that the term 'intersex' relates to the elements of this entire axis or alignment the sex chromosomes, the gonads and the genitalia , and not just to the appearance of the external genitalia. A patient with the complete form of AIS CAIS , or with Swyers Syndrome XY gonadal dysgenesis , will always appear female externally no ambiguity but she is still intersexed, because she has XY chromosomes and internal testes testicular streak gonads in the case of Swyers that are considered at odds with her external femaleness. First off, please note that it is nonsense to talk, in relation to sport for example, of 'gender testing' because gender is to a large extent a social construct, describing the way people present themselves to the world and so cannot usefully be subjected to 'verification'. Rather, it is the notion of sex that Olympic committees and the like are seeking to police. Neither of the latter terms is one that we recognise as belonging in any general discussion of intersex. See the paper by Mazur et al cited at foot of this page. The problems this causes Moreover, the prefix trans- infers a "moving across", and although a few people with intersex conditions may choose to change their gender role, the vast majority never "go" anywhere in terms of their sex or their gender, but are happy to stay in the status in which they grew up. XY females may suffer various problems on finding out their diagnosis. These are the issues that are of major concern to most of our members; and none of these necessarily means that their inner sense of gender identity is compromised. Yet even specialist clinicians will sometimes use the more general term 'intersex' when they are actually referring specifically to patients with outwardly observable 'ambiguous genitalia'. Many intersexed patients have a totally female phenotype body form , and usually no gender ID conflicts. Yet they are still intersexed because their internal features e. The vast majority of our members have a secure female gender identity. Yet it has been known for a CAIS group member with, by definition, no external genital ambiguity to agree the text of an article based on her story one that concentrates on secrecy, confusion about her diagnosis, isolation etc. Or else an article will discuss the issues quite sensibly, using the non-emotive term 'androgen insensitivity', but when the featured group member finally sees it on the newstand she finds that a huge headline has been splashed across the cover page again, without consulting her This meant that a new variant of the term, i. Most of our members detest these hermaphrodite terms, just as those with AIS find the old name testicular feminisation syndrome for their specific condition deeply offensive. This is deeply traumatising for a teenager who in all respects except for her internal organs appears to be female and who often has only come to medical attention through a failure to menstruate and we feel these archaic terms should be banned from the medical literature. If he was going to use these out-of-date and confusing terms then Callie like the vast majority of our members with AIS, 5-alpha-reductase deficiency, Swyers syndrome etc. As mentioned above, this is an umbrella term for someone with certain male characteristics XY sex chromosomes, internal testes yet certain female characteristics female external genitalia and general body form, breasts etc. But this is splitting hairs for most people, and rather than use either archaic term, it would have been much better if Eugenides had just used the more up-to-date term, 'intersex'. The DSD terminology and the way it was introduced has been controversial in some circles. Male foetuses usually have a Y sex chromosome which initiates the formation of testes and the suppression of female internal organ development during gestation. Testes are the site of production of masculinizing hormones androgens in large quantities. Both male and female foetuses usually have at least one X sex chromosome, which contains a gene that gives their body tissues the capacity to recognise and react to androgens. People with AIS have a functioning Y sex chromosome and therefore no female internal organs , but an abnormality on the X sex chromosome that renders the body completely or partially incapable of recognising the androgens produced. In the case of complete androgen insensitivity CAIS , the external genital development takes a female form. In the case of partial insensitivity PAIS , the external genital appearance may lie anywhere along the spectrum from male to female. People with these 'XY conditions' may identify as female, intergendered, or male. All foetuses have non-specific genitals for the first 8 weeks or so after conception. After a few weeks, in an XY foetus without AIS , the non-specific genitals develop into male genitals under the influence of male hormones androgens. Embryonic testes develop inside the body and start to produce androgens. In AIS, these androgens cannot complete the male genital development due to a rare inability to use the androgens that the testes produce so the development of the external genitals continues along female lines. However, another hormone produced by the foetal testes suppresses the development of female internal organs. So in a genetically male XY foetus the active intervention of male hormones androgens is needed to produce a fully male system. A female body type with female external genitalia is the basic underlying human form. In about two thirds of all cases, AIS is inherited from the mother. In the other third there is a spontaneous mutation in the egg. The scale runs from AIS Grade 1 to Grade 7 with increasing severity of androgen resistance - and hence decreasing masculinization with increasing feminization. Some babies with PAIS may be raised as males but many are re-assigned as female.
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