Sex and Gender – Essential but Messy (Part 1)

By Elizabeth Dangerfield

PART ONE – MESSY SEX

What you don’t know about sex

Please note: This article, whilst scientific in purpose and nature, contains explicit material which some people may find offensive.

Many shades of grey

One of the first actions of Donald Trump on becoming President of the United States was to sign an executive decree that there were only two sexes – male and female. Like most people who see things as black or white he likes to slot things and people neatly into in one category or another. It means you can deal with an issue and move on to the next decree to make reality fit your ideology.

But reality will defy you because diversity is inevitable. When you look deeply into any group you will see differences between members because variations will arise with time. There is nothing good or bad about this process, it just happens but it makes the boundaries between the sexes blurry. It means that sex is not black and white: not in humans and not in other living things. It is messy, fluid and amazing and completely natural. No matter how many decrees you pass you cannot change biology.

In the biological world the sexual proclivities of living things are extremely varied. Some animals, such as snails, are hermaphrodite. Some animals, such as clown fish, can change from one sex to the other over their lifetime. Lizard-like living fossils in New Zealand, the tuatara, don’t need to have sex to produce offspring. Some species kill their mates after sex such as the promiscuous female green anaconda. Other animals such as the wolf are monogamous and mate for life. Males often raise offspring. Many animals such as black swans, exhibit homosexual behaviour. There is no black and white sex in nature, it is whatever works for that species at that time.

Messy sex chromosomes – sexual aneuploidy

Contrary to President Donald Trump’s decree not all people are typical males (with a X and a Y sex chromosome) or females (with XX sex chromosomes) because chromosomes don’t realise they have to conform to strict rules of black and white sex. Approximately 1 in 400 live births show an atypical number of X or Y chromosomes known as sexual aneuploidy but this could be higher as these conditions are under reported.  

Sexual aneuploidy occurs because sometimes, in the process of forming sperm and eggs in humans (meiosis), things get a bit messy and the sex chromosomes may not separate properly. This means that while most human embryos have 44 chromosomes plus two sex chromosomes; some have only 44 + X, others have extra chromosomes such as 44 + XXY, or 44 + XXX, or 44 + XYY or other variants. The presence of a Y gene means that the foetus will be male but sometimes a significant part of the Y chromosome ends up on a X chromosome causing a variant where a female has male characteristics as well.

Children born with these different set of chromosomes may face extra challenges because of these differences can affect their development. However they can usually live independent and normal lives with support. It is extremely important that children with these differences are not ignored or derided by people with little knowledge of biology or compassion. Parents and schools need to know these conditions exist because children need acceptance, support and encouragement at an early age, and often hormone treatment, to help them lead happy and productive lives.

Differences in sexual development – Sexual ambiguity

Surprisingly, all embryos start off with the same tissue capable of turning into female or male parts. Usually, the process of differentiation into male or female occurs between 6-9 weeks of pregnancy. The SRY gene on the Y chromosome acts as a master switch to trigger the development of the testes which then produce testosterone which triggers the further development of male characteristics. By 20 weeks the sex organs are fully developed. If all goes according to the individual’s genetic code the child will be born male or female.

But of course, sex is messy and doesn’t always go according to plan. Sexual ambiguity means that babies are born with both male and female internal and external parts to a greater or lesser extent. It can effects both male (XY) and female (XX) foetuses and is usually caused by variations in the availability of sex hormones that affect the development of sexualcharacteristics as well as genetic traits. As a result babies are born with components of both male and female genitalia to a greater or lesser extent, sometimes referred to as intersex or differences of sexual development (DSD). For example, it is possible for an DSD person to have a uterus and perhaps give birth.

People who are sexually ambiguous may appear normal enough at birth to be raised as either girls or boys without parents being aware they are different. Then at puberty things maychange. For example, the güevedoces DSD people in the Dominican Republic are raised as girls when they are born but, around age 12, when they commence puberty, their start to develop masculine features including male genitalia. 

In the past, DSD babies were frequently given surgery to look like females because of the assumption there were only two rigidly defined sexes. Often children in this situation didn’t understand what was happening to them. Their childhood and teenage years could be a very difficult, lonely even damaging experience. Sometimes parents were not told about the real reasons for surgery because it was considered shocking and shameful.

It is very important that parents and schools know about these conditions in order stop hiding the truth, to better help DSD children, and to ensure they are not stigmatised. Open-mindedness is also necessary for better decision-making on how best to deal with the condition given that some DSD people are happy in their own skin and don’t wish to have medical intervention. In 2024, the United Nations passed a ground breaking resolution, put forward by Australia, Chile, Finland, and South Africa, on the rights of intersex people.

In a more tolerant society, DSD people can get help earlier and choose how to manifest their sexuality and live happy and productive lives. There is no doubt that sex is not black and white for people with DSD.

Messy sex hormones

Sex hormones are messy as we know from puberty. Puberty may be essential for young humans to develop the ability to have sex and babies, develop pair bonds and nurture children but it an extended period of metamorphosis that can trying for both teenagers and their parents. Is also gives some indication of the power of sex hormones.

In may be surprising to some, but sex hormones are not black and white because in reality there are no male and female sex hormones as they are produced in both men and women. Women produce estrogen in their ovaries, but also in their adrenal glands and in fat tissue. Men produce lesser amounts of estrogen in their testes and adrenal glands. In men, testosterone converted to estrogen helps balance libido, mood regulation, and emotional well-being. Women produce testosterone in the ovaries and adrenal glands and men produce it in the testes. While women have much lower amounts of testosterone than men it contributes to their libido and the ability to have an orgasm. In men it is also important for sexual arousal and performance. Women produce more progesterone than men as it is important for reproduction. It is also vital to men’s reproductive health as it helps convert testosterone into its active form.

These hormones, and others, are responsible for pregnancy, puberty, menstruation, menopause, sex drive, sperm production and differences between males and females. But they have health benefits that go way beyond sex and reproduction. They are essential for maintaining bone density, strength, cardiovascular health, and skin elasticity in both sexes. They also help muscle mass maintenance and fat distribution and energy levels in both sexes. They are essential for the emotional well-being and cognitive health of both men and women. Estrogen strengthens the immune response and testosterone tends to suppress the immune response.

The level of a particular sex hormone can vary significantly between individual men, and between individual women, and still be perfectly normal. For example, normal testosterone level for adult XY males is between 300 and 1,000 ng/dL but some research suggests that the healthiest men have testosterone levels between 400 and 600 ng/dL. Normal levels of testosterone in XX women are 9-55 ng/dL some reports suggest that it can be as high as 120 ng/dl. One thing is for sure, a balance of all these sex hormones is necessary for our wellbeing.

When sex hormones make life difficult

Sex hormones can make life difficult for women if they are elite athletes with elevated levelsof testosterone competing in at the international level. The question is whether it is fair for such women to compete against women with normal levels of testosterone? This is a real ethical dilemma and leads to trying to define who is a woman, and whether it should be mandatory for such women to take hormonal treatment to reduce their level of testosterone.

In the general population, a significant number of women considered female from birth have high testosterone levels.

The most common reason is polycystic ovary syndrome (PCOS) where a hormonal imbalance causes the ovaries to produce unusually high levels of androgens (the male sex hormones including testosterone). Although it can affect young girls it is generally not detected until women are in their 20s and 30s and can lead to health complications. It is estimated that it effects 6-12% of women or more in the United States.

Both men and women with congenital adrenal hyperplasia can produce unusually elevated levels of testosterone. In this condition genetic mutations cause a shortage of enzymes needed in the adrenal glands to produce cortisol. Instead the adrenal glands produce an excess of testosterone and other hormones. Congenital adrenal hyperplasia is the major cause of ambiguous genitalia.

In Androgen Insensitivity Syndrome a genetic mutation that prevents males (XY) from using testosterone, a male hormone, effectively. This can lead to various developmental issues for including ambiguous genitalia or the development of female external genitalia in individuals. In other words testosterone is produced but does not result in fully developed male sexual organs.

Some tumours of the ovaries or testes can release androgens resulting in an excess of testosterone. And rarely, tumours of the adrenal glands can produce testosterone, or estrogen or both.

The World Athletics body has established rules that effectively ban women with high levels of testosterone from competing in certain athletic events. It is an effort to maintain a level playing field for women competing in such events and to encourage girls and women to aim to become elite athletes. However, this comes at a high cost to athletes such as Caster Sameyena who now find themselves in limbo. Drawing an artificial boundary to define who can compete when there is a spectrum of differences, may be necessary, but has wider social ramifications.

Sex is essential

Many people search for the meaning of life but in biological terms, the purpose of life is to produce more life. And the process of evolution means that some of our offspring will be better able to adapt to changes in the environment so they can reach maturity and reproduce and so the species continues. Most of us are genetically programmed to have a strong urge to have sex and to nurture our offspring to ensure they survive to maturity. If we didn’t do this the human race would die out.

A small, but significant, number of people are sexually different to the norm. They can be ignored and belittled, but they will still exist no matter how many presidential decrees are signed. It is not their fault that sex is messy, but it is our fault if we do not treat them with respect and acceptance. We are not superior to anyone simply because of our sexual characteristics, we are merely different.

Continued tomorrow… link to Part 2

 

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