[37r7rudjduj]

I realize this might be rude but I'm not sure what the polite way to ask is, isn't your sex always your birth sex for the most part? Outside the effects of the medications and the cosmetic effects of the surgery isn't your body still mostly the same as far as the nuts, bolts, and genetic disorders, are concerned?

[mkr-hn]

That depends on what you mean by "sex." And even then, it's not a neat binary thing by any definition. Most things that involve humans fall on a bimodal distribution. Cropping out the wide fields in that distribution is convenient for statistics, forms, and rhetoric, but it doesn't reflect the true range humans are capable of.

[37r7rudjduj]

Can you elaborate on this more? I meant "sex" in the way that my physician would use the word. I'm aware of things like intersex conditions but, unless someone is actually intersex or otherwise complicated, your reply doesn't really answer my original question.

[transatlantic38]

I'm not that poster but I can elaborate. Basically your physician couldn't easily use "biological sex" as a blanket term to accurately asses the risk factors and health needs of a medically transitioned person. Our sex is "otherwise complicated."

The reason for this is that medical transition, primarily through the mechanism of hormone replacement therapy, actually changes some aspects of biological sex and the associated risk factors at a "nuts and bolts" level even though its not touching every single aspect of biological sex. It's not purely cosmetic, though that's a common misconception. Hormones ultimately control a lot about how human bodies express sex and the associated medical factors. In reality "biological sex" is composed of multiple sexually differentiated systems within the human biology that can theoretically operate somewhat independent of each other, and changing the dominate hormone in your body will flip or at least shove a lot of those systems towards the other end of the distribution. I guess a way to phrase this in developer terminology would be that "biological sex" is sometimes a leaky abstraction.

As a personal example: despite my birth sex, it would be a mistake for my doctor to ask that I routinely get regular breast cancer screenings in the same way it would be a mistake to ask a cis man to regularly screen himself for breast cancer. My risk of breast cancer is much lower than a cis woman's and comparable to a cis man's. But at the same time I have absolutely zero risk of prostate cancer, and it would also be a mistake to try and test for that based on any possible symptoms I'm having. An ideally perfect doctor would be able take my history and be cognizant of what risk factors of biological sex, exactly, which conditions were associated with, and then be able to map that onto my body to figure out what I'm at risk for. As you can probably imagine, this is very difficult to do. A lot of times what makes a condition linked to sex isn't actually understood in the first place.

[37r7rudjduj]

I wanted to say thanks for giving such a detailed reply. I still have some things that I'm unsure about as far as the framing of everything but having concrete examples like your point about your lowered risk of breast cancer is immensely helpful in understanding where I'm making social judgements vs. just being ignorant about the topic as a whole. It's often hard to get clear answers like yours because just phrasing these kinds of questions often feels like a minefield. So your patience in answering what I'm sure is an at least somewhat demeaning line of questioning is very appreciated and helps a lot in wrapping my head around this.

[transatlantic38]

I appreciate this, thanks. Answering these kinds of questions can feel like unwrapping bandages in front of strangers. So it's good to hear that it helped somebody out. Thank you for your empathy.

[alicemaz]

when it comes to this topic, "sex" "gender" "male" "female" "man" "woman" etc etc are overloaded with contradictory meanings by people trying to make sneaky ontological arguments. unless I'm specifically talking about the signifier itself, I don't really care about these kinds of games, so I just try to say unambiguous things

anyway aside from language legerdemain, the word "sex" is also used to refer to what sex you're legally designated as, which is only loosely coupled to biology by now

[DavinMiler]

The terms "gender" and "sex" are defined differently by different people, but in general the definition is something like this: Sex is usually defined in terms of genitalia, genotype (chromosomes) or similar biological properties. However, this is still not a binary male/female property, see for example intersex people. Depending on your definition, undergoing surgery may change your sex, gender, or both.

[implements]

Should intersex conditions be considered normal human genetic variances (like eye colour), or genetic disorders (like Down Syndrome)?

It’s humane and polite not to describe people as abnormal, but being medically accurate I’d argue that humans are indeed binary sexed, and immutably so.

[sascha_sl]

It really depends where you draw the line of "intersex condition", it's not really a term physicians specialized in the field use anymore, because variance in sexual development is ubiquitous if you look hard enough. "DSD" is typically used when there's a pronounced effect that is physically diagnosable, but it often misses other neurological factors that, for instance, corelate in transgender people.

Then again, a lot of severe conditions that would often fall under the DSD umbrella are often overlooked until they become somehow important. For instance, complete androgen insensitivity, so zero functional testosterone in an XY individual, is often not diagnosed until you notice the lack of periods / cervix.

Calling it bimodal is a much more precise way to go about it that acknowledges we have two broad categories, with lots of exceptions and caveats.

[dragonwriter]

> Should intersex conditions be considered normal human genetic variances (like eye colour), or genetic disorders (like Down Syndrome)?

Doesn't really matter, for this purpose.

> I’d argue that humans are indeed binary sexed, and immutably so.

Unless you defining terms such that the variations are not merely disorders but actually nonhuman, you are clearly wrong; human alignments of sex characteristics are non-binary though bimodal.

[implements]

> human alignments of sex characteristics are non-binary though bimodal.

You either produce sperm, or ova - or neither (which if caused genetically is an abnormal variant).

“Producing the wrong gamete for one’s perceived gender doesn’t construct an additional sex, nor alter the definition of sex such that there are female sperm / male ova producers - this holds even if that perception has genetic as well as psycho-environmental causes” - in my opinion.

But .. we’re philosophical / political at this point .. which is the problem.

[dragonwriter]

> You either produce sperm, or ova - or neither (which if caused genetically is an abnormal variant).

Or both, at least in theory, though true hermaphroditism with both ovulation and spermatogenesis, while theoretically possible and observed on other mammals has not, AFAIK, been conclusively shown in humans.

But, sure, you can redefine “sex” to be restricted to any one of a number of axes of sexual variation that exist in human and result in either a simple quaternary, trinary (or, if you try a little harder than you have, binary) distinction, but what is the point?

[alicemaz]

the commonly accepted estimate for intersex conditions is 1.7% of lives births, via https://pubmed.ncbi.nlm.nih.gov/11534012/ from this basis it's not much of a stretch to imagine the reality is that there's a greater spectrum of sex difference that is illegible because it hasn't been medicalized. certainly seems like a more plausible explanation than "ok ok, so there's people who don't fit into our perfect platonic ideal categories, but other than the 1.7% of weirdos the categories are still perfect"

it's god of the gaps thinking, people are addicted to drawing clean lines around discrete categories as a vestige of modernism. taxonomy brain. we don't have good ways to say "there are two major clustering points, which most people are roughly close enough to one or the other to call them that, but there's enough overlap and so many dimensions that it makes drawing clean boundaries impossible"

I suspect as gene sequencing gets commoditized and personalized medicine actually becomes practical, we'll find a lot more cases where it makes sense to analyze people on the basis of their individual traits rather than what broad groups we can class them under

[spicywatermelon]

Medication has a profound effect.