Sexing Bodies: Gender, Medicine, and Intersex Identity

What Is at Stake in Scientific Pursuit of Sex Differences

What is fundamentally at stake in the continued scientific pursuit of essential differences between males and females is the entire lived experience of intersex people, whose bodies and medical fates are shaped by mainstream medicine's gender biases. Not only modern America but also the world at large demand that a person be classified as either male or female in unquestioning conformity with medical norms. Consider a mainstream physician who encounters a newborn with both male and female external genitalia. If the male sex organ measures less than 3 centimeters, the physician may decide that it should be "repaired" to conform to genital norms. The doctor shortens the small phallus to resemble a clitoris through surgical procedures and unilaterally declares the newborn to be a girl. An intersex person—also called intersexual—is someone who possesses both male and female external genitals. The medical "correction" of such anatomy happens without the child's consent or understanding.

Opposition to this continuing scientific research and medical practice comes mainly from intersex adults who underwent these surgeries as children and had no power to refuse. Their overall welfare and bodily autonomy were at stake in those decisions, yet these adults doubt that the physicians performing the surgeries prioritized their wellbeing or gave it genuine consideration. These advocates call this medical assault "sex policing"—the enforcement of binary sex categories on bodies that resist such classification. Physicians, meanwhile, defend their actions and invoke societal expectations that children be assigned and raised as either boys or girls. Schools are even severely penalized for deviating from these determined categories, embedding the binary system throughout institutions.

Recent scientific studies appear to bolster the claim that meaningful differences exist between the sexes in both capabilities and physiological characteristics. One study suggests that males have superior navigational skills and higher reproductive success than females. Conducted by Dr. Layne Vashro, a postdoctoral researcher in anthropology at the University of Utah, the research involved more than 120 male and female volunteers from the Twe and Tjimba tribes in northwest Namibia. Through navigational tasks and reproductive history, male volunteers demonstrated greater travel distance and range as well as more offspring than female volunteers. The findings emphasized that having multiple mates benefits males more than females, potentially explaining the observed gap between the sexes.

Males and females also differ in brain size, function, and structure according to neuroimaging research. Recent MRI studies found that some brain regions in women are larger than in men relative to total cerebral volume. Neuroscientist Larry Cahill of the University of California, Irvine investigated sex differences in the brains of both animal and human subjects. His findings challenged the traditional assumption that males are superior research subjects because women's fluctuating hormones supposedly made them unstable subjects. These findings provided evidence of genuine gender differences in brain structure. One key conclusion was that sex differences begin as early as the womb. Early fetal exposure to the sex hormone testosterone triggers male development in guinea pigs and appears to direct both brain development and typical male behavior. Female fetuses developed mating behaviors later in life. Animal research also identified structural differences between the sexes, particularly in the hypothalamus, the anteroventral periventricular nucleus, and dendrites, suggesting that males and females differ in brain circuitry.

Other MRI studies showed that the hippocampus in women is larger than in men, while the amygdala is larger in men than in women. The amygdala is the brain region where emotionally charged memories form. When subjects watched a violent film, women's amygdala showed stronger activation in the left hemisphere while men's amygdala was more strongly activated in the right hemisphere. Men had greater difficulty recalling details of an emotional story, while women found it harder to recall peripheral details a week later. This suggests that men are more capable of recalling the main idea of an emotional story or incident, while women are more inclined to recall specific details. Additionally, gender appears to influence vulnerability to certain diseases. Boys are more prone to autism and attention deficit hyperactivity disorder (ADHD) than girls early in life, but women and girls are twice as prone to depression as men and boys. Women are also more vulnerable to Alzheimer's disease than men. Margaret McCarthy of the University of Maryland School of Medicine, who studies the effects of hormones on brain development, proposed that differences in sex make one gender more vulnerable to particular diseases at certain times than the other. Her 2012 article in The Journal of Neuroscience contended that one sex may be vulnerable to a particular disease while protecting the other sex. She concluded that developing sex-specific preventive medicines could improve treatment or identify new drug targets.

Hacking's Concept Applied to Sexed Bodies

Philosopher Ian Hacking offers a framework for understanding how sex categories are produced through social and institutional mechanisms rather than discovered in nature. Hacking (1999) argues that there is no acceptable way of "making up people" except in separate and particular ways, which cannot be universally generalized. Mental diseases and disorders, for example, were not recognized in the distant past until a certain century. He exemplifies Arnold Davidson's claim that perversions and perverts did not exist before a new functional understanding of disease was formally established in the late nineteenth century. The process of making up people occurs between a doctor and patient, two poles of development linked by "intermediary relations." One pole is the patient as a living, functioning entity presented in bodily form. The second pole is the doctor, focused on the patient's body as a specimen. This medical focus considers the patient's biological processes, diseased condition, health status, life expectancy, and everything learned in medical training. Their relationship is aptly described as the "bio-politics of the population"—the malleable mind and body of the patient subjected to the manipulation of the doctor trained to impose gendered differences, identify diseased conditions, and determine appropriate treatment.

The ways of making up people are numerous and reinforcing. Individuals function as role models and thereafter establish new roles. The advertising industry plays a powerful part in hammering those roles into public consciousness. Dynamic nominalism is the applicable doctrine, which states that human beings and their acts coordinate in inventing their own labels. In the context of sex and gender, this means that what we call "male" and "female" are not pre-existing natural kinds waiting to be discovered, but categories actively produced through repeated institutional, medical, and social practices. The binary sex system is not revealed by science; it is constructed and maintained by it.