Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-04T08:17:00.121Z Has data issue: false hasContentIssue false
  • English
  • Français

Securing Cisgendered Futures: Intersex Management under the “Disorders of Sex Development” Treatment Model

Published online by Cambridge University Press:  01 January 2020

Catherine Clune‐Taylor
Get access Rights & Permissions [Opens in a new window]

Abstract

In this critical, feminist account of the management of intersex conditions under 2006's controversial “Disorders of Sex Development” (DSD) treatment model, I argue that like the “Optimal Gender of Rearing” (OGR) treatment model it replaced, DSD aims at securing a cisgendered future for the intersex patient, referring to a normalized trajectory of development across the lifespan in which multiple sexed, gendered, and sexual characteristics remain in “coherent” alignment. I argue this by critically analyzing two ways that intersex management has changed between OGR and DSD: 1) regarding sex‐assignment recommendations for three patient populations and, 2) with the prenatal treatment of pregnant individuals at risk of conceiving a fetus with congenital adrenal hyperplasia with the steroid hormone dexamethasone. I conclude that like OGR before it, DSD also unjustifiably presumes that typical genitalia are necessary for cisgendered development. However, unlike OGR, it appeals to the empirically inadequate, theoretically suspect, and biologically determinist model of gender development known as brain‐organization theory. Given this, I conclude that the treatment of intersex people under DSD continues to be driven by problematically heterosexist and transphobic assumptions regarding the value and normalcy of cisgendered life, while practically and discursively constituting it as such.

Type
Articles
Information
Hypatia , Volume 34 , Issue 4 , Fall 2019 , pp. 690 - 712
Copyright
Copyright © 2019, Hypatia, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almeida, Joanna, Johnson, Renee M., Corliss, Heather L., Molnar, Beth E., and Azrael, Deborah. 2009. Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence 38 (7): 1001–14. https://doi.org/10.1007/s10964-009-9397-9.CrossRefGoogle ScholarPubMed
Arboleda, Valerie A., Sandberg, David E., and Vilain, Eric. 2014. DSDs: Genetics, underlying pathologies and psychosexual differentiation. Nature Reviews Endocrinology 10 (10): 603–15. https://doi.org/10.1038/nrendo.2014.130.CrossRefGoogle ScholarPubMed
Chase, Cheryl. 1999. Rethinking treatment for ambiguous genitalia. Pediatric Nursing, July 1. https://link.galegroup.com/apps/doc/A55577832/AONE?sxml:id=googlescholar.Google Scholar
Chase, Cheryl. 2013. Hermaphrodites with attitude: Mapping the emergence of intersex political activism. In The transgender studies reader, ed. Stryker, Susan and Whittle, Stephen. New York: Routledge.Google Scholar
Clune‐Taylor, Catherine E. 2016. From intersex to disorders of sex development: A Foucauldian analysis of the science, ethics and politics of the medical production of cisgendered lives. PhD dissertation, University of Alberta.Google Scholar
Crary, David. 2017. Pressure mounts to curtail surgery on intersex children. Chicago Tribune, July 25. https://www.chicagotribune.com/lifestyles/health/ct-surgery-intersex-children-20170725-story.html.Google Scholar
Creighton, Sarah, Chernausek, Steven D., Romao, Rodrigo, Ransley, Philip, and Salle, Joao Pippi. 2012. Timing and nature of reconstructive surgery for disorders of sex development—Introduction. Journal of Pediatric Urology 8 (6): 602–10. https://doi.org/10.1016/j.jpurol.2012.10.001.CrossRefGoogle Scholar
Creighton, Sarah M., Michala, Lina, Mushtaq, Imran, and Yaron, Michal. 2014. Childhood surgery for ambiguous genitalia: Glimpses of practice changes or more of the same? Psychology & Sexuality 5 (1): 34–43. https://doi.org/10.1080/19419899.2013.831214.CrossRefGoogle Scholar
Davis, Georgiann. 2015. Contesting intersex: The dubious diagnosis. New York: New York University Press.Google Scholar
Davis, Georgiann. 2018. Sex and gender diversity is growing across the US. The Conversation. http://theconversation.com/sex-and-gender-diversity-is-growing-across-the-us-98610.Google Scholar
Diamond, Milton. 1965. A critical evaluation of the ontogeny of human sexual behavior. Quarterly Review of Biology 40 (2): 147–75. https://doi.org/10.1086/404539.CrossRefGoogle ScholarPubMed
Diamond, Milton, and Garland, Jameson. 2014. Evidence regarding cosmetic and medically unnecessary surgery on infants. Journal of Pediatric Urology 10 (1): 2–6. https://doi.org/10.1016/j.jpurol.2013.10.021.CrossRefGoogle ScholarPubMed
Downing, Lisa, Morland, Iain, and Sullivan, Nikki, eds. 2015. Fuckology: Critical essays on John Money's diagnostic concepts. Chicago and London: University of Chicago Press.Google Scholar
Dreger, A. D., and Herndon, A. M. 2009. Progress and politics in the intersex rights movement: Feminist theory in action. GLQ: A Journal of Lesbian and Gay Studies 15 (2): 199–224. https://doi.org/10.1215/10642684-2008-134.CrossRefGoogle Scholar
Dreger, Alice Domurat. 1998. Hermaphrodites and the medical invention of sex. Cambridge, Mass: Harvard University Press.Google Scholar
Dreger, Alice, Feder, Ellen K., and Tamar‐Mattis, Anne. 2012. Prenatal dexamethasone for congenital adrenal hyperplasia: An ethics canary in the modern medical mine. Journal of Bioethical Inquiry 9 (3): 277–94. https://doi.org/10.1007/s11673-012-9384-9.CrossRefGoogle ScholarPubMed
Fausto‐Sterling, Anne. 1993. The five sexes: Why male and female are not enough. Sciences 33 (2): 20. https://doi.org/10.1002/j.2326-1951.1993.tb03081.x.CrossRefGoogle Scholar
Fausto‐Sterling, Anne. 2000. Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books.Google Scholar
FDA Pregnancy Categories—CHEMM. n.d. https://chemm.nlm.nih.gov/pregnancycategories.htm.Google Scholar
Feder, Ellen K. 2014. Making sense of intersex: Changing ethical perspectives in biomedicine. Bloomington: Indiana University Press.Google Scholar
Fine, Cordelia. 2010. Delusions of gender: How our minds, society, and neurosexism create difference. New York: W. W. Norton & Company.Google Scholar
Flores, Andrew R., Herman, Jody L., Gates, Gary J., and Brown, Taylor N. T. 2016. How many adults identify as transgender in the United States? Los Angeles: The Williams Institute (UCLA).Google Scholar
Foucault, Michel. 1970. La situation de Cuvier dans l'histoire de la biologie. Revue d'histoire des sciences et de leurs applications 23 (1): 49–92.Google Scholar
Germon, J. 2009. Gender: A genealogy of an idea. Dordrecht: Springer.CrossRefGoogle Scholar
Gettler, L. T., McDade, T. W., Feranil, A. B., and Kuzawa, C. W. 2011. Longitudinal evidence that fatherhood decreases testosterone in human males. Proceedings of the National Academy of Sciences 108 (39): 16194–99. https://doi.org/10.1073/pnas.1105403108.CrossRefGoogle ScholarPubMed
Hatipoğlu, Nihal, and Kurtoğlu, Selim. 2013. Micropenis: Etiology, diagnosis and treatment approaches. Journal of Clinical Research in Pediatric Endocrinology 5 (4): 217–23. https://doi.org/10.4274/Jcrpe.1135.Google ScholarPubMed
Hirvikoski, Tatja, Nordenström, Anna, Wedell, Anna, Ritzén, Martin, and Lajic, Svetlana. 2012. Prenatal dexamethasone treatment of children at risk for congenital adrenal hyperplasia: The Swedish experience and standpoint. Journal of Clinical Endocrinology & Metabolism 97 (6): 1881–83. https://doi.org/10.1210/jc.2012-1222.CrossRefGoogle ScholarPubMed
Holmes, Morgan. 2008. Intersex: A perilous difference. Selinsgrove, Penn.: Susquehanna University Press.Google Scholar
Houk, Christopher P., and Lee, Peter A. 2010. Approach to assigning gender in 46, XX congenital adrenal hyperplasia with male external genitalia: Replacing dogmatism with pragmatism. Journal of Clinical Endocrinology & Metabolism 95 (10): 4501–08. https://doi.org/10.1210/jc.2010-0714.CrossRefGoogle ScholarPubMed
Hughes, Ieuan A. 2010. The quiet revolution: Disorders of sex development. Best Practice & Research. Clinical Endocrinology & Metabolism 24 (2): 159.Google Scholar
Jordan‐Young, Rebecca M. 2010. Brain storm: The flaws in the science of sex differences. Cambridge, Mass.: Harvard University Press.Google Scholar
Kaiser, Anelis, Haller, Sven, Schmitz, Sigrid, and Nitsch, Cordula. 2009. On sex/gender related similarities and differences in FMRI language research. Brain Research Reviews 61 (2): 49–59. https://doi.org/10.1016/j.brainresrev.2009.03.005.CrossRefGoogle ScholarPubMed
Karkazis, Katrina. 2008. Fixing sex: Intersex, medical authority, and lived experience. Durham, N.C.: Duke University Press.Google Scholar
Kelly, B. A., Lewandowski, A. J., Worton, S. A., Davis, E. F., Lazdam, M., Francis, J., Neubauer, S., Lucas, A., Singhal, A., and Leeson, P. 2012. Antenatal glucocorticoid exposure and long‐term alterations in aortic function and glucose metabolism. Pediatrics 129 (5): e1282–90. https://doi.org/10.1542/peds.2011-3175.CrossRefGoogle ScholarPubMed
Kessler, Suzanne J. 1990. The medical construction of gender: Case management of intersexed infants. Signs: Journal of Women in Culture and Society 16 (1): 3–26. https://doi.org/10.1086/494643.CrossRefGoogle Scholar
Kirkland, Faye. 2017. Great Ormond Street Hospital failing intersex children. BBC News. https://www.bbc.com/news/uk-41593914?ns_mchannel=social&ns_campaign=bbc_england&ns_source=twitter&ns_linkname=english_regions.Google Scholar
Lee, P. A., Houk, C. P., Ahmed, S. F., and Hughes, I. A., and in collaboration with the participants in the International Consensus Conference on Intersex organized by the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology. 2006. Consensus statement on management of intersex disorders. Pediatrics 118 (2): e488–500. https://doi.org/10.1542/peds.2006-0738.CrossRefGoogle ScholarPubMed
Lee, Peter A., Houk, Christopher P., and Husmann, Douglas A. 2010. Should male gender assignment be considered in the markedly virilized patient with 46, XX and congenital adrenal hyperplasia? Journal of Urology 184 (4, Supplement): 1786–92. https://doi.org/10.1016/j.juro.2010.03.116.CrossRefGoogle ScholarPubMed
Lee, Peter A., Nordenström, Anna, Houk, Christopher P., and Faisal Ahmed, S. 2016. Global disorders of sex development update since 2006: Perceptions, approach and care. Hormone Research in Paediatrics 85 (3): 158–80.CrossRefGoogle ScholarPubMed
Lee, Peter, Schober, Justine, Nordenström, Anna, Hoebeke, Piet, Houk, Christopher, Looijenga, Leendert, Manzoni, Gianantonio, Reiner, William, and Woodhouse, Christopher. 2012. Review of recent outcome data of disorders of sex development (DSD): Emphasis on surgical and sexual outcomes. Journal of Pediatric Urology 8 (6): 611–15. https://doi.org/10.1016/j.jpurol.2012.10.017.CrossRefGoogle ScholarPubMed
Mader, Mary Beth. 2011. Modern living and vital race: Foucault and the science of life. Foucault Studies 12 (September): 97–112. https://doi.org/10.22439/fs.v0i12.3336.CrossRefGoogle Scholar
Mak, Geertje. 2012. Doubting sex inscriptions, bodies and selves in nineteenth‐century hermaphrodite case histories. Manchester, UK: Manchester University Press. http://www.jstor.org/stable/10.2307/j.ctt155jh15.Google Scholar
Meyer‐Bahlburg, H. F. L., Dolezal, C., Haggerty, R., Silverman, M., and New, M. I. 2012. Cognitive outcome of offspring from dexamethasone‐treated pregnancies at risk for congenital adrenal hyperplasia due to 21‐hydroxylase deficiency. European Journal of Endocrinology 167 (1): 103–10. https://doi.org/10.1530/EJE-11-0789.CrossRefGoogle ScholarPubMed
Meyer‐Bahlburg, Heino F. L. 2005. Gender identity outcome in female‐raised 46, XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Archives of Sexual Behavior 34 (4): 423–38. https://doi.org/10.1007/s10508-005-4342-9.CrossRefGoogle ScholarPubMed
Miller, Walter L., and Auchus, Richard J. 2011. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocrine Reviews 32 (1): 81–151. https://doi.org/10.1210/er.2010-0013.CrossRefGoogle ScholarPubMed
Miller, Walter L., and Witchel, Selma Feldman. 2013. Prenatal treatment of congenital adrenal hyperplasia: Risks outweigh benefits. American Journal of Obstetrics and Gynecology 208 (5): 354–59. https://doi.org/10.1016/j.ajog.2012.10.885.CrossRefGoogle ScholarPubMed
Money, John. 1995. Gendermaps: Social constructionism, feminism and sexosophical history. London: Bloomsbury.Google Scholar
Nimkarn, Saroj, and New, Maria I. 2010. Congenital adrenal hyperplasia due to 21‐hydroxylase deficiency: A paradigm for prenatal diagnosis and treatment. Annals of the New York Academy of Sciences 1192 (1): 5–11. https://doi.org/10.1111/j.1749-6632.2009.05225.x.CrossRefGoogle ScholarPubMed
Reis, Elizabeth. 2009. Bodies in doubt: An American history of intersex. Baltimore: Johns Hopkins University Press.Google Scholar
Rider, G. Nicole, McMorris, Barbara J., Gower, Amy L., Coleman, Eli, and Eisenberg, Marla E. 2018. Health and care utilization of transgender and gender nonconforming youth: A population‐based study. Pediatrics 141 (3). https://doi.org/10.1542/peds.2017-1683.CrossRefGoogle ScholarPubMed
Rippon, Gina, Jordan‐Young, Rebecca, Kaiser, Anelis, and Fine, Cordelia. 2014. Recommendations for sex/gender neuroimaging research: Key principles and implications for research design, analysis, and interpretation. Frontiers in Human Neuroscience 8 (August). https://doi.org/10.3389/fnhum.2014.00650.CrossRefGoogle Scholar
Rosario, V. A. 2009. Quantum sex: Intersex and the molecular deconstruction of sex. GLQ: A Journal of Lesbian and Gay Studies 15 (2): 267–84. https://doi.org/10.1215/10642684-2008-138.CrossRefGoogle Scholar
Rosner, G., Shachar, S. B., Yaron, Y., and Evans, M. I. 2006. Prenatal therapy of endocrine and metabolic disorders. In Textbook of perinatal medicine. https://doi.org/10.3109/9781439814697-87.CrossRefGoogle Scholar
Roughgarden, Joan. 2004. Evolution's rainbow: Diversity, gender, and sexuality in nature and people. Berkeley: University of California Press.Google Scholar
Rubin, David A. 2012. “An Unnamed Blank That Craved a Name”: A Genealogy of Intersex as Gender. Signs: Journal of Women in Culture and Society 37 (4): 883–908. https://doi.org/10.1086/664471.CrossRefGoogle Scholar
Spurgas, Alyson K. 2009. (Un)queering identity: The biosocial production of intersex/DSD. In Critical Intersex, ed. Holmes, Morgan. Oxford and New York: Routledge.Google Scholar
Warne, Garry L., Grover, Sonia, and Zajac, Jeffrey D. 2005. Hormonal therapies for individuals with intersex conditions: Protocol for use. Treatments in Endocrinology 4 (1): 19–29. https://doi.org/10.2165/00024677-200504010-00003.CrossRefGoogle ScholarPubMed
Yiee, Jenny H., and Baskin, Laurence S. 2010. Penile embryology and anatomy. Scientific World Journal 10: 1174–79. https://doi.org/10.1100/tsw.2010.112.CrossRefGoogle ScholarPubMed
Zucker, Kenneth J. 1996. Commentary on Diamond's “Prenatal predisposition and the clinical management of some pediatric conditions”. Journal of Sex & Marital Therapy 22 (3): 148–60. https://doi.org/10.1080/00926239608414653.CrossRefGoogle Scholar